The body’s severe response to an infection is sepsis – a potentially fatal condition that must be identified quickly and treated immediately. Research revealed that the global mortality rates of around 60% were lower than those for sepsis and septic shock (Myrstad et al., 2020). Moreover, its incidence and severity are increasing worldwide (Myrstad et al., 2020). Sepsis is preventable, and the accompanying mortality, morbidity, and cost burden can be reduced with early diagnosis and therapy. However, sepsis symptoms are usually generic, mild, and easily overlooked in an emergency triage or prehospital scenario (Da Costa et al., 2018). Since traditional systemic inflammatory response syndrome (SIRS) criteria were unsuitable for use in triage, National Clinical Guideline for sepsis management required a more fitting evaluation and prediction tool (Department of Health, 2021). Consequently, National Early Warning Score (NEWS) became a life-saving solution for both patients and healthcare professionals.
The Royal College of Physicians created NEWS to help better identify deterioration and response in adult patients and to initiate standardization of response measures in acute cases. This tool is essential for enhancing patient outcomes and ensuring patient safety. In December 2017, the Royal College of Physicians released NEWS2, an update to the original 2012 NEWS first version (Myrstad et al., 2020). NHS England and NHS Improvement support using NEWS2 in ambulatory and acute settings.
When NHS England teamed up with the Royal College of Physicians (RCP), Health Education England, and NHS Improvement, they released a NEWS2 resource bundle in January 2019 (Song et al., 2020). The toolkit, developed with clinical input, provides access to tools and resources, such as ISBAR (Table 1), that enable the development and implementation of NWES2 and also provide examples of performance from throughout the country in the real world. NEWS2 has been used extensively in England, with 76% of acute and 100% of ambulance trusts using it (Song et al., 2020). Other early warning scores are utilized in various healthcare sectors (Myrstad et al., 2020). The NEWS is a standardized tool that aids in lowering the number of patients whose diseases worsen while they are receiving hospital care and preventing practice deviations that can compromise patient safety. According to estimates, this technique can save more than 1,800 lives a year (Goulden et al., 2018). Every organization involved in health care should strive to provide high-quality patient care.
Table 1: ISBAR tool evaluation
Even for patients with severe illnesses like cancer, such high levels of care boost good patient recovery experiences, including improving their emotional and physical quality of life. Each patient’s healthcare demands should be taken into consideration when providing care. Instead of providing treatment generically, addressing each patient’s specific demands guarantees that every crucial need is satisfied. Keeping precise records of fluid balance is vital while caring for critically ill patients. This is because such individuals require sufficient maintenance of their fluid balance.
Dehydration is typically caused by excessive fluid loss or insufficient fluid intake, which compromises the control of electrolytes and adversely impacts renal and cardiac function. Making necessary decisions to facilitate the proper maintenance of the patient’s fluid and electrolyte balance will be informed by precise fluid balance information. When a patient receives care, a healthcare professional can see vital signs indicating they are deteriorating. These include sweaty or clammy skin, low body temperature (below 35 degrees Celsius), respiration rates (less than 8 per minute), heart rates (less than 40 per minute), and systolic blood pressure (less than 70) (Goulden et al., 2018). NEWS has a 95% success rate in accurately predicting hospital mortality, making it a helpful tool (Goulden et al., 2018). Sepsis describes a condition in which the body overreacts to an infection, creating a critical situation that could endanger life. The disease sets off a series of events that spread throughout the body. The skin, gastrointestinal system, urinary tract, and lungs are the primary sites of septic infections.
Early treatment of sepsis is necessary as it can cause organ failure, tissue damage, and death. Sepsis symptoms include confusion, fever, shortness of breath, low blood pressure, rapid heartbeat, and perspiration on the skin. Only a medical evaluation by a licensed healthcare practitioner can determine whether a patient has sepsis. Sepsis suspects should receive urgent medical attention. As soon as possible, seek medical attention, and take the patient to the emergency room for a checkup (Hu et al., 2020). Prompt diagnosis and treatment can increase survival likelihood (Hu et al., 2020). The healthcare professional must follow the hand hygiene guidelines and utilize personal protective equipment as directed when caring for critically ill patients (Gofulden et al., 2018). Hand washing stops the transmission of germs, especially those resistant to antibiotics. Nosocomial conditions that were absent at admission develop in a hospitalized patient. Personal protective equipment is essential to prevent infection when in contact with blood or other bodily fluids.
To prevent the spread of germs, donning gloves, masks to cover the mouth and nose, eye protection, and clothing like gowns and aprons are all examples of personal protective equipment. A scoring system called NEWS monitors the criteria for patient deterioration (Gofulden et al., 2018). It entails routinely tracking a patient’s fundamental psychological indicators, examining abnormal parameters, and acting appropriately. The problem of the disparate Early Warning Score systems formerly utilized across the nation was resolved by the creation and implementation of NEWS. Overall score computation involves measuring physiological parameters such as respiratory and heart rates, systolic blood pressure, and degrees of oxygen saturation and consciousness. Individual scores between 0 and 3 are added to create an overall score (Myrstad et al., 2020). Two more points are added if the patient is undergoing oxygen therapy. The possible total scores are 0 to 20, inclusive (Myrstad et al., 2020). A higher score indicates a higher clinical risk for the patient (Table 2). As a result, a patient with a higher score requires increased monitoring, medical reviews, and potential clinical intervention.
Table 2: Escalation protocol for NEWS above 3
NEWS was created to assist doctors in identifying patients with looming or already present severe illnesses and to enable such patients to access expert care. For instance, a NEWS score of 5 is a reliable indicator of potential sepsis cases (Da Costa et al., 2018). According to a survey conducted in 2018, NEWS was being used in 65% of hospitals, 14% of hospitals were using some variation of NEWS, and 20% were using other early warning systems (Da Costa et al., 2018). However, NEWS has not been regularly adopted in acute hospitals. A realistic, streamlined, and systematic method of safe communication among healthcare professionals is provided by the ISBAR tool. Articles and lecture notes will serve as the sources for the data in this section.
It can be difficult to give patients clinical treatment that is standardized. Various elements, including diverse care contexts and complex patient manifestations, cause this (Gofulden et al., 2018). It takes safe, efficient care and treatment to give patients the best available care. The Department of Health believes that promoting evidence-based practice through the clinical effectiveness framework is essential for the health system to provide safe and high-quality care (Da Costa et al., 2018). A primary recommendation from the Commission on Patient Safety and Quality Assurance’s 2010 report established the Ministerial body, the National Clinical Effectiveness Committee (NCEC) (Myrstad et al., 2020). A growing understanding of patient safety issues in general and highly publicized failures of the health service delivery systems at home and abroad led to the creation of the Commission.
In conclusion, NEWS2 is a life-saving instrument that must be appropriately implemented thoughtfully and systematically. With its use, hospitalized patients’ conditions have worsened slowly, and early discovery has allowed focused therapy delivery. It is an excellent approach to identifying patients who need immediate medical attention before they become ill, lowering unnecessary hospitalizations, and easing pressure on the acute healthcare system. In evaluating the patient’s condition, NEWS2 should be used in addition to clinical judgment. Early warning systems must actively include the populations at risk, promote public education and risk awareness, effectively broadcast messages and alerts, and guarantee a constant level of preparedness if they are to be effective.
Reference List
Da Costa, C.A., Pasluosta, C.F., Eskofier, B., Da Silva, D.B. and da Rosa Righi, R. (2018) ‘Internet of health things: toward intelligent vital signs monitoring in hospital wards’, Artificial intelligence in medicine, 89, pp. 61-69. Web.
Department of Health. (2021) Department of Health publishes the National Clinical EffectivenessCommittee’s National Clinical Guideline No. 26 sepsis management for adults (includingmaternity). Web.
Foley, C., and Dowling, M. (2019) ‘How do nurses use the early warning score in their practice? A case study from an acute medical unit’, Journal of Clinical Nursing, 28(7-8), pp. 1183-1192. Web.
Gofulden, R., Hoyle, M.C., Monis, J., Railton, D., Riley, V., Martin, P., Martina, R. and Nsutebu, E. (2018) ‘qSOFA, SIRS, and NEWS for predicting in-hospital mortality and ICU admission in emergency admissions treated as sepsis’, Emergency Medicine Journal, 35(6), pp. 345–349. Web.
Hu, H., Yao, N. and Qiu, Y. (2020) ‘Comparing rapid scoring systems in mortality prediction of critically ill patients with novel coronavirus disease’, Academic Emergency Medicine, 27(6), pp. 461-468. Web.
Moi, E. B. et al. (2019) ‘The ISBAR tool leads to conscious, structured communication by healthcare personnel’, Sykepleien Forskning, 14, p. 74699. Web.
Myrstad, M., Ihle-Hansen, H., Tveita, A.A., Andersen, E.L., Nygård, S., Tveit, A. and Berge, T. (2020) ‘National Early Warning Score 2 (NEWS2) on admission predicts severe disease and in-hospital mortality from Covid-19–a prospective cohort study’, Scandinavian Journal of Trauma, Resuscitation, and Emergency Medicine, 28, pp. 1-8. Web.
Song, C.Y., Xu, J., He, J.Q. and Lu, Y.Q. (2020) ‘COVID-19 early warning score: a multi-parameter screening tool to identify highly suspected patients’, MedRxiv, pp. 2020-03. Web.