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Early warning scores in hospital for nurse

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DEEPARANI ALAGARSAMY
DEEPARANI ALAGARSAMY

Early warning scores (EWS) are used to facilitate early detection of patient deterioration. The EWS system assigns points to physiological parameters like respiration, oxygen saturation, blood pressure, and temperature to determine a total score. This score dictates the frequency of monitoring and urgency of clinical review. Higher scores indicate more frequent monitoring and quicker medical review are needed. The system aims to standardize recognition of worsening conditions and ensure prompt treatment. Case studies are presented to demonstrate how EWS would be applied in clinical practice.

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Early warning scores
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)
HOW EARLY WARNING SCORE WORKS ???
A standardized system for early recognition of deterioration in patients’ condition, obtaining urgent assistance for them, and ensuring that the required skills, knowledge and equipment are available as needed.
PHYSIOLOGICAL PARAMETERS • AGE • URINE OUTPUT • PAIN • GENDER / ETHINICITY & OBESITY • CO MORBIDITIES AND IMMUNOSUPRESSION
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.
CLINICAL RESPONSE TO NEWS • THREE MAIN COMPONENTS FREQUENCY OF MONITORING COMPETENCY OF TEAM URGENCY OF CLINICAL REVIEW
CLINICAL PROCESS MEASUREMENT & DOCUMENTATION OF INFORMATION ESCALATION OF CARE EMERGENCY RESPONSE SYSTEMS CLINICAL COMMUNICATION
NEWS SCORING SYSTEM
SCORING SYSTEM …CONTD • Each parameter carries a point. If the patient receive oxygen an additional 2 points will be added with final score
Early warning scores in hospital for nurse
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 .
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 .
HELPS TO PRIORTIZE CARE STREAMLINE COMMUNICATION REDUCE HUMAN ERROR RESPONSE RIGHTAT THE POINT OF CARE
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??
• Respiration – 1 • Oxygen saturation – 0 • Supplemental oxygen – 0 • Temperature - 1 • Systolic BP -1 • Heart rate - 1 • Level of consciousness – 3 • TOTAL = 7 - RED
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 ???
• Respiration – 3 • Oxygen saturation – 1 • Supplemental oxygen – 2 • Temperature - 0 • Systolic BP -0 • Heart rate - 1 • Level of consciousness – 3 • TOTAL = 10- RED
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 ?
• Respiration – 0 • Oxygen saturation – 0 • Supplemental oxygen – 0 • Temperature - 0 • Systolic BP -3 • Heart rate - 0 • Level of consciousness – 0 • TOTAL = 3 - MEDIUM SCORE • EXTREME VARIATION
EWS SYSTEM WILL WORK ONLY IF STAFFS ARE TRAINED IN EWS RESPONSE SYSTEMS AND STAFFARE IN PLACE TO DELIVER CARE MEASURE AND RECORD THE SYSTEM FOR EACH PARAMETER MEASURE AND RECORD THE SYSTEM FOR EACH PARAMETER
Early warning scores in hospital for nurse

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Early warning scores in hospital for nurse

  • 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)
  • 4. A standardized system for early recognition of deterioration in patients’ condition, obtaining urgent assistance for them, and ensuring that the required skills, knowledge and equipment are available as needed.
  • 5. PHYSIOLOGICAL PARAMETERS • AGE • URINE OUTPUT • PAIN • GENDER / ETHINICITY & OBESITY • CO MORBIDITIES AND IMMUNOSUPRESSION
  • 6. 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.
  • 7. CLINICAL RESPONSE TO NEWS • THREE MAIN COMPONENTS FREQUENCY OF MONITORING COMPETENCY OF TEAM URGENCY OF CLINICAL REVIEW
  • 8. CLINICAL PROCESS MEASUREMENT & DOCUMENTATION OF INFORMATION ESCALATION OF CARE EMERGENCY RESPONSE SYSTEMS CLINICAL COMMUNICATION
  • 10. SCORING SYSTEM …CONTD • Each parameter carries a point. If the patient receive oxygen an additional 2 points will be added with final score
  • 12. 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 .
  • 13. 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 .
  • 14. HELPS TO PRIORTIZE CARE STREAMLINE COMMUNICATION REDUCE HUMAN ERROR RESPONSE RIGHTAT THE POINT OF CARE
  • 15. 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??
  • 16. • Respiration – 1 • Oxygen saturation – 0 • Supplemental oxygen – 0 • Temperature - 1 • Systolic BP -1 • Heart rate - 1 • Level of consciousness – 3 • TOTAL = 7 - RED
  • 17. 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 ???
  • 18. • Respiration – 3 • Oxygen saturation – 1 • Supplemental oxygen – 2 • Temperature - 0 • Systolic BP -0 • Heart rate - 1 • Level of consciousness – 3 • TOTAL = 10- RED
  • 19. 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 ?
  • 20. • Respiration – 0 • Oxygen saturation – 0 • Supplemental oxygen – 0 • Temperature - 0 • Systolic BP -3 • Heart rate - 0 • Level of consciousness – 0 • TOTAL = 3 - MEDIUM SCORE • EXTREME VARIATION
  • 21. EWS SYSTEM WILL WORK ONLY IF STAFFS ARE TRAINED IN EWS RESPONSE SYSTEMS AND STAFFARE IN PLACE TO DELIVER CARE MEASURE AND RECORD THE SYSTEM FOR EACH PARAMETER MEASURE AND RECORD THE SYSTEM FOR EACH PARAMETER