Early warning scores

EWS help to identify the early deterioration of patients

1. Early warning scores Mrs. Parvathy Tutor, sjcon

2. DEFINITION Early Warning Scores have been developed to facilitate early detection of deterioration by categorizing a patient’s severity of illness and prompting nursing staff to request a medical review at specific trigger points utilizing a structured communication tool (Mitchell et al., 2010)

3. HOW EARLY WARNING SCORE WORKS ???

4. PHYSIOLOGICAL PARAMETERS AGE URINE OUTPUT PAIN GENDER / ETHINICITY & OBESITY CO MORBIDITIES AND IMMUNOSUPRESSION

5. INCLUSION CRITERIA FOR EARLY WARNING SCORES Acute hospital setting All patients above 16 yrs of age – initial assessment Outpatients / and day care patients who comes for invasive procedures or those who receive anesthesia.

6. EXCLUSION CRITERIA

7. CLINICAL RESPONSE TO NEWS THREE MAIN COMPONENTS

8. CLINICAL PROCESS

9. NEWS SCORING SYSTEM

10. SCORING SYSTEM …CONTD Each parameter carries a point. If the patient receive oxygen an additional 2 points will be added with final score

11. A low score : an aggregate NEWS of 1–4 A medium score: a NEWS aggregate score of 5 or more, or a RED score, ie an extreme variation A high score: an aggregate NEW score of 7 or more

12. A low NEWS score can be attended by competent registered clinical nurse RN can determine the frequency of monitoring / or need for escalation of care.

13. NEWS medium scores should be attended by ward level doctor or by a acute care nurse .

14. NEWS high score should be taken care by critical care outreach team – and usually transfers patients to high dependency area.

15. FREQUENCY OF CLINICAL MONITORING Patients who scored zero should be monitored every 12 hours Medium scored patients should be evaluated every 4 hours High score patients should be evaluated hourly .

16. RELEVANCE OF EWS IN INDIA Acute /Tertiary care hospitals in India are overloaded – helps to relieve burden of care EWS helps on call teams to prioritize their works – which case need most urgency in attending A modified tool accurate to Indian setting can be developed according to hospital protocols .

17. CASE STUDY – 1 Mr. R is a 75 year old man , found lying on the street by police. On assessment his BP is 100/75 mm Hg , Pulse rate is 110 beats / mts, respiration is 9 breaths/ mts temperature is 102 F and SPO2 is 98%. Classify the patient??

18. Respiration – 1 Oxygen saturation – 0 Supplemental oxygen – 0 Temperature - 1 Systolic BP -1 Heart rate - 1 Level of consciousness – 3 TOTAL = 7 - RED

19. CASE STUDY – 2 Mr. John ,34 year old was admitted to EMD after he was found unconscious in his apartment by his wife . On examination Respiratory rate was 26 breaths/mt Heart rate – 102 beats/mt SPO2- 94@2l O2 Temperature- 98.6 F BP- 120/80 mm Hg- classify ???

20. Respiration – 3 Oxygen saturation – 1 Supplemental oxygen – 2 Temperature - Systolic BP -0 Heart rate - 1 Level of consciousness – 3 TOTAL = 10- RED

21. CASE STUDY 3 Mrs.Roger a 45 year old women presented to OPD with complaints of head ache. On examination Respiratory rate – 16 breaths/mt Heart rate – 78 beats/mt BP- 180/220 mm Hg SPO2- 98 % @ room air Classify the patient ?

22. Respiration – Oxygen saturation – Supplemental oxygen – Temperature - Systolic BP -3 Heart rate - 0 Level of consciousness – TOTAL = 3 - MEDIUM SCORE EXTREME VARIATION

23. TAKE HOME MESSAGES

24. EWS SYSTEM WILL WORK ONLY IF