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Nurses 'crucial' to plan to save 6,000 lives with new bed chart


A national system for recording vital signs and identifying deteriorating patients could save up to 6,000 lives a year, leading clinicians have claimed.

The Royal College of Nursing and the Royal College of Physicians have worked together to develop the National Early Warning Score (NEWS) system for recording vital signs in adults.

They want to see it introduced in acute and community hospitals, nursing homes and ambulance services to increase consistency, reduce mistakes and ultimately improve outcomes for patients.

A recent study published in the journal BMJ Quality and Safety found there were nearly 12,000 avoidable deaths of adults in English acute hospitals annually. It found almost a third of these could be attributed to poor clinical monitoring, 29.7% from diagnostic errors and 21.1 % from inadequate drug or fluid management.

Bryan Williams, chair of the NEWS working party and professor of medicine at University College London, estimated up to half of these deaths could be avoided by standardising early warning systems.

“The problem is there are many different scoring systems in use, even between wards,” he said. “That creates a huge problem because if we are talking to each other about a patient’s condition a score of five in one area could mean something completely different in another area.”

Professor Williams also said it would make it easier for staff when moving to a new organisation and could be incorporated into clinicians’ training.

He added: “It’s been so vital to us to have nursing teams on board because at the end of the day it’s nurses who take the measurements, who make decisions about whether to escalate… This is not an incremental change it’s a transformative change.”

The chart is colour coded and includes a scoring system that weights the different vital signs.

The observational charts and supporting guidance is all available for free online along with an e-learning training module.

Chair of the RCN’s critical care and in-flight nursing forum David Quayle said nurses would be “crucial” to making sure it was taken up nationally.

“This is not expensive… it’s much cheaper to identify patient in earlier stages of deterioration and do something about it and a better patient experience.”

Rachel Binks, a nurse consultant at Airedale Foundation Trust and a member of the forum, welcomed the NEWS system but said it needed to be backed up by critical care response teams. Ms Binks said in her trust there was an edict that staff would be disciplined if they did not escalate in line with early warning score policy.

“It needs to come from the top. Boards need to understand how important it is to empower the nurses and junior medical staff to escalate when patients are beginning to deteriorate,” she said.


Readers' comments (51)

  • What nurses need to do is learn to correctly interpret what the patients vital signs are telling them.
    Putting them on a standard piece of paper without ensuring they have the knowledge to read and understand won't save lives.
    Nor will relying on the HCA's to do the obs

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  • Anonymous | 27-Jul-2012 11:10 am

    absolutely! and to take responsibility for carrying out and interpreting observations skilfully and correctly.

    there is a long ongoing debate on it in the DT.

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  • I think it's good to standardise the paperwork, especially as staff often move between hospitals, wards and different parts of the country. I myself will be unlikely to find work in Scotland when I qualify.

    That said, I think it's sad that 6,000 lives will be saved by this. A sheet of paper. All the NEWS (or MEWS, as NHSGG&C broadly uses currently) does is highlight problems that a trained nurse should ideally be able to spot anyway. It's brilliant for me as a student in that it helped me memorise the mean values and gain an idea of what are 'good' and 'bad' readings but a trained nurse should be able to interpret the data without the aid. That said, on a busy ward things can be missed, we're all human. More paperwork should really be standardised, with aims to reducing it or making more of it electronic. Rather than entering the same value a dozen times on various sheets of paper a computer could do it for you, the only worry being security and the general lack of IT skills I've found in the profession on placements.

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  • Latterlife Midwife

    Agree with Anonymous | 27-Jul-2012 11:10 am, and Anonymous | 27-Jul-2012 11:26 am completely.

    It is part of normal nursing assessment and action to interpret and proceed with critical thinking to do what needs to be done. However, whether due to staffing problems, patient acuity, all the usual suspects, the beauty of these paper systems is that they are colour-coded.

    If you haven't seen then, the multitude of obs readings at one time are transcribed and fall onto coloured sections of white, yellow, or red, indicating their normal, suspicious, or critical status. At the bottom, the number of occurrences of each colour are tallied, requiring notification of the doctor (and perhaps other actions in some locations) if two yellows, or one red.

    Of course, the proper action needs to be carried out to be worth the paper it's printed on, but at least there are then no excuses to be made that someone didn't see a trend developing, or a critical change occurring.

    It may be the height of dumbing-down, but it will and does save lives if they are followed correctly and acted upon promptly. I can't really argue with that when sepsis is becoming so relatively common.

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  • I listened to the guy behind this on the radio this morning, and although I have not yet seen the chart, my impression was that is a sheet (perhaps a couple) to sit at the front of the patient's notes, recording just the most critical indicators, with some type of 'alert warnings' built into the chart - so that the process of recording the measurement, would in itself highlight if a measurement was a cause for some further action.

    If that is right, it seems a good idea to me - part of this must indeed be a prompt to seek more expertise 'if in doubt', as opposed to just recording readings and doing nothin else. My impression, was that the chart itself does this (like 'red lines' on speed indicators, for WW2 aircraft, to indicate that exceeding the speed could result in structural failure - knowing the limiting safe speed, is backed up by seening it in front of you).

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  • Latterlife Midwife

    Grant Byrne | 27-Jul-2012 11:38 am, well said! Logging said observations once into a computer (and okay, maybe once on paper) and having it put into appropriate places automatically would be a wonderful thing. Not just time saved, not just mistakes caught, but a less bulky and much neater set of patient notes. Bring it on, quickly!

    Just as an aside, the phrase "trained nurse" always puts in my mind an image of dogs or seals balancing balls on their noses. We are not trained, like animals. We are educated in the professional arts and sciences. I think we need to permanently dump "trained" and adopt something else. Perhaps "Registered Nurse" says it all? As far as I know, people don't say "trained doctor," do they?

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  • I despair, nobody except nurses themselves seem to have any understanding at all of the jobs we do or the vital roles we play in patient care and recovery.

    I get the impression that employers, managers, government, some patients and the public see nursing as the execution of certain tasks, many of which anybody with a little training or common sense, could do.

    what everybody seems to fail to appreciate is all the advanced knowledge, highly developed skills and experience we use in parallel with all these tasks such as a keen sense of observation and interpretation which goes far beyond measuring and recording a few vital physiological signs as well as nursing interventions which require excellent and often split-second decision-making, and also excellent communication and interpersonal skills.

    All of this together with
    an understanding of psychology, emotional intelligence and of human behaviour as well as a very large number of practical skills is what makes nursing unique and what makes a difference to the care a patient as an individual receives.

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  • I'm for It but it seems that some Hypertensive Urgency readings will sit in areas that won't alert the user, which isn't very useful. nursing students for examples or hca's who may use it to flag up to an rn's attention is there any additional information about this I may have overlooked it

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  • A NEWS system does not allow for variation in speciallity, what is a warning sign for one is not for another. Case in point there is no allowance for urine output in this system, which is very important for cardiothoracic patints.

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  • Anonymous

    I should perhaps point out, that the report about this in the Daily Telegraph states that it is something to be used by nurses and also by HCAs - I don't think the idea is to claim that nurses are not qualified, but rather to make sure that somebody qualified definitely 'takes a look' when that is needed.

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