now I've been using the national early
warning score as a trap and trigger
system in hospital practice for some
years now so I thought it would come
back and give you an update of how it's
working out for us practically so
patient label has drawn Campbell today
that we're thinking about normally this
would be a sticky label with the
patient's name address date of birth and
a chest number on it and it's the 20th
of the ninth day and it's 1300 now we
always want to use the 24-hour clock
system so we don't get confused between
AMS and PMS and first of all the
parameter here is respire Ettore right
now anything that's white doesn't score
anything that's colored does score so
between 12 and 20 breaths per minute
which of course we need to always have
our little watch around with us for
these are dirt cheap these days I
compared our 99p for them they're very
handy to have them in your pocket and
just to wear a take this pirate race now
between 12 and 20 we see is not scoring
but if it's 21 to 24 if it's fast then
that's going to score too because that's
the key that yellow is it too if it's
above 25 that's going to score a three
if the respite rate is 9 to 11 we see
that's a green color and that scores a
Warner and if the sprite was prior to
rate is between is less than 8 that's
going to score a red so that again
that's a 3 so we would write those
parameters in there so let's suppose my
respite rate is relatively normal is 14
in the moment going on down we come to
oxygen saturations now oxygen
saturations again they can be 96 to 100
is considered normal low if the
patient's got chronic obstructive
pulmonary disease will accept perhaps 88
to 92 percent saturations there but for
normal people will expect 96 97 98
99 to be alarmed about the level the
rule would expect so that say mine's 97
today which it was last time I checked
it now green would be 94 to 95 and we
see that scores are one yellow would be
92 to 93 percent oxygen saturations and
we see that scores a two if that comes
up red would be anything less than 91
but of course we need to know the
patient's on oxygen or not and if the
patient's on oxygen that scores a two so
the patient's on two liters of oxygen
that scores it too but at the moment I'm
on room air so I'm just going to put
array in there now the patient is not on
oxygen don't forget to put room air in
there otherwise we're not sure if
someone's picking this up they might not
be sure going on down to temperature
again we see the temperature here was
acceptable between 36 and 38 without
scoring last time I took my temperature
it was earth 36.6 right in there at that
level and you can see I'm writing it at
about the level where where it is now in
the old days when we did TPR beeping
temperature course respiration we always
put dots in there so we could get a
trend but now we use the numbers
themselves to be more accurate and to
get the trend and again we can see 38 to
39 would score a green which is a 1 on
the new score and above 39 would scroll
a 2 on the new score now going on to
blood pressure new score for blood
pressure now the new score for blood
pressure uses the systolic blood
pressure so in terms of scoring whether
it's in here or in any of these we're
talking about the systolic blood
pressure so the diastolic blood pressure
is not really a criteria for news
although we would need to use our
clinical initiative from time to
last time I took my blood pressure 125
one to five over 75 and again you know
time writing in the figure one to five
at the right place 75 there at the right
place
that's the systolic that's the diastolic
and we noticed that the 125 is well into
the white so it's not scoring so a
systolic blood pressure above 220 would
score a 3 i systolic blood pressure of
between 100 and 110 would score a 1 a
systolic blood pressure of 90 to a
hundred would score a two and a systolic
blood pressure below 90 would score a
three
moving on to heart rate so again we see
the normal heart rate is considered to
be 50 to 90 on the on the news criteria
we normally define a sinus rhythms
between 60 and 100 but these are the
criteria that the Royal College of
Physicians have come up with and they do
work in practice so last time I took my
heart rate it was 78
so that's 78 there that's where the 78
will go instead of the dot we put it in
that place and we noticed that between
nineteen fifties okay ninety to a
hundred and ten beats per minute would
score the green which is a 1 110 to 130
would score a yellow which is 2 and
above 130 would score a 3 then it's the
same for the slow Highbury conditions as
we see 40 to 50 would score a 1 less
than 40 would score a through you now we
move on to level of alertness and the
scale we use here is a V P you are they
alert are the responsive to voice are
they responsive to pain or are they
unresponsive so at the moment I'm alert
I'll put an A in there for me
and now I can add up my total news score
on our car because I'm dumb a
blood-sugar last time I did my blood
sugar was 5.6 million moles of glucose
per liter which is in a normal range for
two ages we'll fit the parameters though
that we typically see now I can add this
up so here I get a zero for that I get a
zero for that because it's in the white
I'm on room air ever been an oxygen that
would have scored two but I'm on room
air so it doesn't attempt of just 36 six
which is in the white my systolic blood
pressure is one two five which is in the
white so that doesn't score my heart
rate is seventy eight which is in the
white some of that doesn't score does
that gives me a total new score of zero
but then I need to go down and just
finish off the rest of it paying out of
North out of ten at the moment I'm glad
to say I'm not in pain so I get a zero
for that I haven't passed you on in the
past hour so that's actually a zero
although that can be normal because of
course urine will accumulate in the
bladder now monitoring frequency I'm not
too worried about me at the moment so I
think I put myself on for hourly ops
don't do upset before Ally at the moment
I don't have an escalation plan and then
I'll sign to say I've taken these
observations so you see I've completed
every single box don't leave any bits
uncompleted the bits that are often left
uncompleted uh sometimes the time very
often the oxygen or the room air that
the patient on is incomplete sometimes
people don't do the avpu score we don't
always do the blood sugar of course it's
only a we happen to test it then we do
the blood sugar although with the advent
of non-invasive blood glucose monitoring
that will be a more common observation
and then we always add up the total
score now the total score is greater
than one we'll need a registered nurse
to assess that and to sign it at the
bottom
the given that my score was zero at the
moment I don't need to get the staff
nurse to assess that because I'm quite
happy with those parameters so that's
the first part of this video on normal
recording of news and of course what we
want to do is look at trends so for
example if my saturations were going
down that would form a trend of my
respite free rates were going up that
would form a trend in this white racial
going up but my temperature was changing
that could form a trend or my blood
pressure was dropping that could form a
trend and triggering alarm bells
especially was going into any of the
colors part rates again what is the
trend is it becoming progressively
faster or progressively slower and what
about my level of alertness is it
fluctuating sometimes am I only
responding to voice and bear in mind the
other parameters always considering the
possibility that I might be in pain
always ask me if I'm in pain because
pain is what the patient says it is
assisting when the patient says it does
so that's the first basic introductory
part to the new score what we're going
to look at next in the next clip is what
highs and lows can occur in each of
these parameters and what is the
clinical significance and causes of
possible alterations in any of these
news parameters