The National Early Warning Score (NEWS) is an observations screening tool which improves the detection and response to clinical deterioration in patients and is a key element of patient safety and improving patient outcomes. It was first implemented in 2012 and NEWS2 was rolled out in December 2017.
The Sepsis Trust is the leading UK based charity promoting early diagnosis and treatment of sepsis and they state that it is estimated that, every year sepsis costs the NHS £2 billion and claims the lives of at least 52,000 people. They urge clinical staff to think sepsis in the context of infection when a NEWS score is 5 or above.
The NHS observation charts incorporate the NEWS scoring. It would appear to be a relatively simple exercise to complete a full set of observations; temperature, heart rate, respiration rate, oxygen saturation, conscious level and blood pressure and calculate the NEWS score. However, in practice there are numerous examples where the clinical staff fail to accurately calculate the NEWS score and/or complete the appropriate action.
This can include failures in simple mathematical calculations of the figures which at the maximum can only be 23. It would seem inconceivable that a medical professional could fail to add up to 23 accurately but this is a common finding when reviewing charts.
The second failure is often the failure to respond to what the NEWS score is indicating and take appropriate action. All NHS hospitals will have a set of guidelines on what action to take depending on the NEWS score. This would include who to request a medical review from, how urgently and when to repeat the observations. Studies have repeatedly demonstrated that prompt action saves lives.
The clinical negligence team at Hugh James have acted for numerous clients that have suffered harm as a result of failures to calculate and act upon raised NEWS scores. Examples include; deteriorating patients not being treated promptly and suffering serious complications to many cases of preventable death.
When a person is developing sepsis their observations will become deranged and they will require urgent treatment with the Sepsis Six. If NEWS scores are not correctly calculated this can lead to a failure to ‘think sepsis’ and start the appropriate treatment within the vital 1-hour timeframe.
In one case dealt with by Lynda Reynolds at Hugh James the NEWS score on arrival in A&E should have prompted a senior doctor’s review but the score was incorrectly added up and no senior review occurred and the patient was discharged home. The patient was only aged 39 and had suffered a minor leg injury which had developed into sepsis. He was readmitted later the same day and again the calculations of NEWS scores was incorrect leading to further delays. He rapidly deteriorated and died within 24 hours.
Evidence heard at his inquest confirmed that the senior doctor would have taken the appropriate action had she been notified of the correct NEWS score, would have commenced treatment for sepsis which would have saved the patient’s life.
The family wanted to ensure that lessons had been learned and the inquest provided an opportunity for the hospital to understand the errors in care and explain what actions had been taken since to reduce the risk of future deaths.
The inquest heard that the hospital trust have implemented additional training on NEWS scoring, sepsis awareness and roll out of electronic observations.
Technology is available to remove the human error factor in calculating NEWS scores and prompting the next steps. In 2015 the NCEPOD report into NEWS scoring highlighted that digital solutions should be an essential part of managing sepsis and urged hospitals to utilise electronic observation recording which automatically calculates the NEWS score and prompts the correct action.
One of the starting points for any potential sepsis clinical negligence claim is a review of the observation charts and whether NEWS scores have been calculated correctly and acted upon. At Hugh James we are starting to see more medical records with electronic observation charts which will eliminate the risk of mathematical errors.