Implementation of a Nurse Early Warning System (NEWS)

Purpose:
Rapid response systems decrease cardiopulmonary arrests in hospitalized patients when activated early.Data indicates patients have undetected signs of deterioration as much as 12 hours before an event.The purpose of this project was to implement a Nurse Early Warning System to expedite activation.

Significance:
Because earlier RRS activation results in better outcomes,NEWS was put in place to expedite RRS calls and prompt additional intervention.After NEWs implementation,patient acuity was 50% lower at RRS activation because signs of impending decline were caught earlier resulting in greater code survival.

Strategy and Implementation:
Lack of putting subtle patient indicators together, low self-confidence in assessment skills, and infrequency of rounding were identified as the major barriers to preventing nurses from summoning rapid response (RRS) quickly. The Nurse Early Warning System ( NEWS) was implemented as an algorithm that uses a physiological scoring system that either prompts a call to RRS or triggers additional assessment. The NEWS score categorizes a patient's condition into 3 groups, each with a specific nursing response based on the score. To ensure compliance of completing a score for each patient and thus heighten to awareness of change in condition, the scoring system was combined with vital sign monitoring. The score is then stratified by one of three categories represented by green, blue or red. A corresponding color marker was then placed on the patients' door to signify the NEWS score to other caregivers.

Evaluation:
Baseline data showed 100% of RRS patients had subtle signs of decline twelve hours prior to the event.After NEWs,RRS calls came within 4 hours or less with a score less than half of baseline. Earlier detection led to more timely and aggressive treatment outside of ICUs and decreased code mortality.

Implications for Practice:
NEWS was found to help nurses detect declining patient conditions earlier and empower them to make RRS calls more quickly resulting in lower patient complications and subsequent codes outside ICUs.