M15p National Early Warning Score NEWS

Procedure: M15p
National Early Warning Score

(NEWS)
Procedure Relates to Primary Policy: B4 – Basic Life Support policy
Version: M15p/04.2
Approved by: Quality Matters Committee
Date approved: 6th September 2016
Title of Author: Nurse Consultant Physical Healthcare
Responsible ED: Medical Director
Date issued: 19th April 2018
Review date: September 2019
Target audience: All clinical staff trust-wide
Disclosure Status (B) B Can be disclosed to patients and the public

Equality & Diversity Statement
The Trust strives to ensure its policies are accessible, appropriate and inclusive for all.
Therefore all policies will be required to undergo an Equality Impact Assessment and will
only be approved once this process has been completed.
The Trust aspires to:

“Ensure the health and wellbeing of those we serve and be a leader in the development of
mental health care and treatment.”
To achieve such an aim, the Trust will need to address the issues raised by its
stakeholders and deliver the kind of service developments and outcomes they describe.
Such an endeavour needs to be underpinned by a core set of values.
West London Mental Health NHS Trust Page 2 of 26

Procedure M15p First Date of Issue: Jan 2012 This is current version M15p/04.2 April 2018
Version Control Sheet
Version Date Title of Author Status Comment

0.01 Aug 10 Lynne Read, Assistant Draft New Policy.
Director of Primary Care Circulated to key members of the
Physical Healthcare Group for initial
comment.
0.01 Sept 10 Lynne Read, Assistant Draft Revised to incorporate comments. To

Director of Primary Care go to the CSSC September 2010.
0.01 Oct 10 Lynne Read, Assistant Final Draft To be approved as a working

Director of Primary Care document at the October 2010 CSSC
0.01 Dec 10 Dr A Cohen, Director of Final Draft For debate/discussion at CSSC

Primary Care
0.01 Jan 11 Lynne Read, Assistant Final Draft To PRG for approval and minor
Director of Primary Care amendments made
0.02 Jan 12 Director of Primary Care Reviewed Ratified by CEC

Procedure
0.02 April 12 Director of Primary Care Reviewed Implementation & monitoring Plans
Procedure updated
th
02 May 12 Director of Primary Care Ratified Ratified by TMT 9 May 2012
03 April 15 Director of Primary Care Review Approved at May CEC.
Sept 15 Reviewed Minor amendments throughout

Procedure procedure, 7.3 (removed), 9.1, 9.2,
11.2, 12.1, 12.2, Apps 1&2. No change
to policy process. Re-issued 15.09.15
04 July 16 Nurse consultant Reviewed and Changes to escalation process to bring

physical healthcare amended it in line with RCP guidance. Changes
to NEWs chart to bring it in line with
RCP guidance. Addition of local
escalation processes to reflect
practice.
Revised &
04.1 November
issued Minor text amend to 6.2.1
2017
04.2
Revised & Minor text amend to Appendix 11.
April 2018 Medium risk - Registered Nurse to
issued
escalate to doctor. Doctor to see
patient within 30 minutes

Contents Page No
1. Flowchart ....................................................................................................................... 5
2. Introduction.................................................................................................................... 6
3. Purpose ......................................................................................................................... 6
4. Scope ............................................................................................................................ 6
5. What is NEWS ............................................................................................................... 7
6. Systems and recording .................................................................................................. 7
7. Recognising a physically deteriorating patient ............................................................... 9
8. When to use NEWS..................................................................................................... 10
9. Observation chart ........................................................................................................ 10
10. NEWS score ................................................................................................................ 10
11. Trigger scores - definitions .......................................................................................... 11
12. How to respond to news ............................................................................................ 111
13. Recording NEWS ........................................................................................................ 12
14. NEWS training ............................................................................................................. 12
15. Monitoring & audit........................................................................................................ 13
16. Associated polices ....................................................................................................... 13
17. Glossary of Terms / Acronyms ……………………………………………………………..13
18. Appendices ………………………………………………………………………………….. 14
19. References……………………………………………………………………………………26
Appendix 1 - NEWS observation chart– front page…………………………………………..15

Appendix 2 - NEWS observation chart instruction – back page…………………………….16
Appendix 3 – Escalation Flowchart - Local Services, Jubilee Ward……………...………...17
Appendix 4 – Escalation Flowchart - Local Services, the Limes……………………………18
Appendix 5 – Escalation Flowchart - Local Services, H&F…………………………………..19
Appendix 6 – Escalation Flowchart - Local Services, Ealing…………………...……………20
Appendix 7 – Escalation Flowchart - Local Services, Hounslow…………………………….21
Appendix 8 – Escalation Flowchart - Local Services, Homeward, Magnolia……………….22
Appendix 9 – Escalation Flowchart - High Secure Services, Broadmoor Hospital……….. 23
Appendix 10 - Guidance for use of NEWS in ECT …………………………………...………24
Appendix 11 – Escalation Flowchart – West London Forensic Services………………..… 25

1. Flowchart
Complete NEWS Chart
NEWS score of 5 or
NEWS score of 1 - 4 more or 3 in one NEWS score of 7 or
parameter more
Clinical risk:
LOW Clinical risk: Clinical risk:
MEDIUM HIGH
 Escalate immediately to
crash team or accident
and emergency via
Inform Nurse in Charge Inform Nurse in Charge ambulance service (see
local escalation protocols)
Registered Nurse to decide if Registered Nurse to escalate 
increased frequency of to doctor. Doctor to see patient
Registered Nurse to
monitoring and/or escalation of within 30 minutes.
clinical care is required immediately inform the
Frequency of monitoring medical team caring for
Frequency of monitoring Minimum 1 hourly the patient.
4-6 hourly
Clinical priority safe
transfer
Document action in notes. Complete IR1 if transferred

Revise Care Plan as necessary

2 Introduction
2.1 Primary policy
2.1.1 The Trust’s Physical Healthcare Strategy describes the ‘interconnection between
mental and physical health’.
2.1.2 It states ‘having a mental problem increases mortality from heart disease1,2,3
coronary heart disease can increase the risk of depression. People with
schizophrenia have a life expectancy that is significantly lower than that of the
general population and have higher rates of serious long term conditions4,5,6People
with mental health problems are also prone to factors that are damaging to overall
health, such as poor diet, heavy smoking and drug and alcohol misuse 7,8. Equally,
people who smoke, are obese or take drugs or behave in other ways that put their
health at risk are more likely to have mental health problems9,10 and may people in
Mental Health Services will have co-morbid physical health problems such as long
term conditions and complex end of life care needs11,12,13.
3 Purpose
3.1 The aim of this policy is to improve people’s outcomes by detecting and acting upon
early signs of deterioration in physical health of patients. This will be in part
achieved through the implementation of the National Early Warning Score (NEWS)
system that:
 Identifies trends in patient observations;

 Ensures that timely patient review and appropriate treatment occurs;
and
 Improves the documentation of patient observations.
3.2 Notification should also occur where clinical deterioration occurs other than that
assessed by the NEWS criteria, or where sound clinical judgement would suggest
that notification is in the best interests of patient care.
4 Scope
4.1 All staff are to record patient observations on the National Early Warning Scores
(NEWS) chart when are taken. Staff are to calculate and record score on the chart
and escalate according to this policy.
4.2 It ONLY applies to people who are current in-patients of West London Mental
Health NHS Trust

5 What is NEWS?
5.1 NEWS14 is an evidenced based system of care, used nationally in acute hospitals to
monitor the progress of patients, and to identify early deterioration in their health. It
has been adopted by many Mental Health Trusts.
5.2 NEWS is a form of track and trigger scoring system. The triggers are based on
routine observations and are sensitive enough to detect subtle changes in a
patient’s physiology which will be reflected in a change of score should the patient
be improving or deteriorating.
5.3 All patients have their vital signs measured and these are converted into a score.
The higher the score the more abnormal the vital signs are. If the scores reach
above a certain threshold, staff must follow the escalation process
5.4 The system allows for the regular monitoring and recording of blood pressure,
pulse, temperature, conscious state, oxygen saturation (pO2) and respiratory rate.
5.5 Early warning scoring systems were originally developed with 2 specific aims:
 To facilitate timely recognition of the patients with established or impending

critical illness; and
 To empower nurses and junior medical staff to obtain experienced help
through the operation of a trigger threshold which, if reached, required
mandatory attendance by a more senior member of staff.
5.6 Use of a NATIONAL Early Warning Scoring system can also:
 Improve the quality of patient observation and monitoring

 Improve communication within the multidisciplinary team
 Allow for timely admission to intensive care (acute hospital)
 Support good medical judgement
 Aid in securing appropriate assistance for sick patients
 Give a good indication of physiological trends
 Are a sensitive indicator of abnormal physiology
NB – It is important that staff understand that NEWS does not replace clinical
judgement
6 Systems and recording

6.1 The elements of the NEWS score, pulse, blood pressure, temperature, respiratory
rate, oxygen saturation, and conscious state should be recorded in the patient’s
electronic record, as well as the individual patient’s paper based record.

6.2 Frequency of recording
6.2.1 All patients who have returned to the ward following an attendance in accident and
emergency or who have been re-admitted to the ward following a stay in an acute
hospital must have their NEWS score recorded immediately on return and
escalated if any clinical concerns
6.2.2 All inpatients will have NEWS score recorded at least 12 hourly for the first three
days of admission. NEWS will normally be taken during the waking cycle. If there
are clinical concerns follow NEWS score for more frequent monitoring or escalation
as appropriate.
6.2.3 In Local Services in-patients with complex care needs i.e. patients on Meridian
Ward, the Limes, Jubilee and Magnolia ward the NEWS score will be recorded at
least 12 hourly for the duration of admission. If there are clinical concerns follow
NEWS score for more frequent monitoring or escalation as appropriate.
6.2.4 In local services other than those wards detailed above NEWS will after the first 72
hours be carried out at least once a week. If there are clinical concerns follow
NEWS score for more frequent monitoring or escalation as appropriate.
6.2.5 In high secure and forensics services NEWS will after the first 72 hours be carried
out at least once a week. After one month NEWS will be carried out monthly. If
there are clinical concerns follow NEWS score for more frequent monitoring or
escalation as appropriate.
6.2.6 Rapid tranquilisation:

NEWS should be completed at least every 15 minutes following injectable Rapid
tranquilisation for at least 1 hour. If no concerns this can be reduced to hourly until
the patient is ambulatory. (See R10 Rapid Tranquilisation Restrictive Practice for
further information including when more frequent monitoring is required).
6.2.7 Zuclopenthixol Acetate Administration:

NEWS should be completed at least every 4 hours following administration of
zuclopenthixol acetate injection. Monitoring is recommended to be continued for 72
hours. (See Z1 Requesting a supply and the administration of Zuclopenthixol
Acetate (Clopixol Acuphase®) for further information).
6.3 The NEWS score dictates the frequency of observations. 1-4 = 4-6 hourly
monitoring. 5 = hourly at least, 7 and above continuous whilst awaiting acute
medical transfer/intervention. The frequency and specifications of all baseline
observations should be written on the NEWS chart and prescribed in the Nursing
Care plan.
6.4 Guidance for use of NEWS in ECT
Patients undergoing ECT treatment - please see Appendix 10
6.4.1 Undertake Physical Observations and NEW Score:

 Prior to ECT at the 'One Stop Clinic'
 Prior to discharge following each ECT treatment
6.4.2 In acknowledgement that a service user’s physical observations are likely to be

volatile immediately prior to treatment and during recovery, there is no requirement
to Score during this period, but to instead record the physical observations on the
NEWS physical observation chart:
 Prior to each ECT treatment

 During ECT Recovery (recorded 3-4 times)
6.5 Reviewing NEWS
6.5.1 Ward rounds / clinical reviews and CPA meetings should routinely include review of
the service user’s physical observations that have occurred. This review should be
recorded in the progress notes on RiO and within the CPA care plan.
6.6 Exceptions
6.6.1 If clinical teams decide that the routine recording of data for the NEWS is not
appropriate, for example, for people on an end-of-life care pathway, such decisions
should be clearly documented in the progress notes and on the service user’s care
plan on RiO.
6.7 Service user refusal
6.7.1 If it is not possible to measure a person’s physical observations, each attempt must
be recorded on the NEWS Physical Observation Chart as “Refused”. Staff must
make repeated offers to undertake physical observations throughout a person’s stay
in hospital.
7 Recognising a physically deteriorating patient

7.1 Clinical deterioration can occur at any stage of a patient’s illness, although there will
be certain periods during which a patients is more vulnerable such as at the onset
of illness, during surgical or medical interventions and during recovery from critical
illness.
7.2 Patients with a diagnosed physical health condition or illness must have a
secondary diagnosis recorded on RiO and agreed care plan must be written
detailing the treatment plan including the signs and symptoms associated with
deterioration.

8 When to use NEWS
8.1 NEWS relies on the routine recording and charting of the physiological status of the
patient however, the frequency of monitoring should be increased if abnormal
physiology is observed. These are simple observations that can be performed by a
nurse, doctor or other trained staff. These observations include:
 Pulse
 Respiratory rate
 Temperature
 Blood pressure
 Oxygen saturation (pO2)
 Conscious state (AVPU)
8.2 The NEWS evidence base does not apply to children or pregnant women –
therefore this guidance is only applicable to adults.
9 Observation chart
9.1 The Trust will use the nationally recommended chart as the standard trust
document
10 NEWS score
10.1 Where there are concerns that a patient is unwell the NEWS observations are
carried out and the results used to gauge the severity of deterioration as indicated.
Table 1

AVPU is a simple assessment where
A = Alert
V = Responds to verbal commands only
P = Responds to Pain
U = Completely Unresponsive
A flow diagram for the use of NEWS is shown in Appendix A.
11 Trigger scores - definitions

11.1 A low score – NEWS 1 – 4
11.2 A medium score is NEWS greater than 5 and/or one parameter score of 3
11.3 A high score is NEWS of 7 or above
12 How to respond to news

12.1 A low score: The Senor Nurse will assess the patient and provide guidance to the
ward staff on the further frequency of recording of physical signs, and other action
that may be appropriate, depending on the clinical state of the patient.
If necessary, the senior nurse will also seek the opinion of the duty doctor, although
it may only be telephone advice that is necessary. See Appendix 2
12.2 A medium score: The duty doctor will assess the patient, and arrange for the
appropriate care to be delivered. The assessment should take place within thirty
minutes of the request being made by the ward staff. This may involve further
monitoring, administration of medication, seeking specialist review, or transferring
the patient to a more appropriate location depending on the clinical symptoms and
signs. See Appendix 2
12.1 A high score: Staff will call for emergency assistance (see relevant appendices for
local protocols) and inform the duty doctor so that the duty doctor can assist in
stabilising the patient prior to transfer to acute care
12.4 This response should be no different whether or not the recording takes place in
hours or out of hours and at weekends.
N.B. A failure to attend a NEWS call within an acceptable timescale (<30

minutes) should result in the completion of an IR1.
12.5 A NEWS action plan must be agreed and documented for any patient reviewed.

13 Recording NEWS
13.1 Observations and NEWS Scores MUST be recorded on the National NEWS
Observation Chart – see Appendix 1. Observations should also be recorded on the
patient electronic record.
13.2 The decision to seek medical advice as a result of a NEWS score should be
recorded on RiO and any advice or treatment provided should also be recorded on
the patient’s electronic record.
13.3 The NEWS score and observations should also be recorded on the patient’s
electronic record
14 NEWS training
14.1 Medical staff will receive information, instruction and training on the NEWS system
on induction and within core-curriculum teaching, and BLS training.
 Nursing staff will receive information, instruction and training on the NEWS
system and accurate observations as part of BLS training.
 NEWS training will be mandatory for registered nursing staff and

incorporated within the BLS training.
14.2 Staff caring for patients with physical conditions should have competencies in
monitoring, measurement, interpretation and prompt response to the acutely ill
patients appropriate to the level of care they are providing. Education and training
should be provided to ensure staff have these competencies and they should be
assessed to ensure they can demonstrate them.
14.3 Using the NEWS observation chart
14.3.1 The NEWS chart replaces previously used TPR charts. This provides a
standardised system for recording routine clinical data for all patients in hospital.
This consistent format, provides familiarity in recognition of patient data and
facilitates training in the measurement and recording of such data in a systematic
and standardised way by all NHS staff.
14.3.2 The NEWS chart contains dedicated sections to record the frequency of monitoring
as defined by the score and the clinical response to a change in score, e.g. an
escalation in acute care – this will facilitate tracking of the response to changes in
the NEWS score. The NEWS chart also contains dedicated sections to record urine
output and pain severity. These do not form part of the NEWS score.
Please note that when the measured physiological parameter exceeds the
range on the chart, the actual value should be recorded on the chart.
14.3.3 Please also note that the NEWS is not designed to replace recognised generic
scoring systems such as the GCS or disease-specific systems.
14.3.4 Reproducing this chart: this chart must be reproduced in colour and in actual size,
and should not be modified or amended.
14.4 The NEWS educational tool
14.4.1 The Royal College of Physicians’ NEWS Development and Implementation Group
(NEWSDIG) commissioned the NHS Training for Innovation team to work with
members of NEWSDIG, including representation from the Royal College of Nursing
and the National Outreach Forum, to develop a standardised generic NEWS chart
that would be suitable for downloading for use by clinical teams across the NHS.
Alongside, an online training package focused on the use of NEWS has been
developed to facilitate implementation
(http://tfinews.ocbmedia.com).
15 Monitoring & audit

 An audit of implementation of NEWS will be undertaken annually by the Clinical
Service Units (CSU).
 Results of the audit will be presented to the Physical Health Group and Clinical
Effectiveness Group
16 Associated polices
The Physical Healthcare Policy (P15)
Physical Healthcare Strategy
First Aid (F3)
Slips, Trips and Falls (F8)
Health and Safety (H3)
Infection Control Policies (ICP1)
17 Glossary of Terms / Acronyms

CSU Clinical Service Unit
NHS National Health Service
TPR Temperature, Pulse and Respiration
BLS Basic Life Support
CPA Care Programme Approach
RiO Records in Operation
ECT Electro-convulsive therapy
NEWS National Early Warning Scores
NEWSDIG The Royal College of Physicians’ NEWS Development and
Implementation Group

18 Appendices
Appendix 1 - NEWS OBSERVATION CHART–front page
Appendix 2 - NEWS OBSERVATION CHART INSTRUCTION – back page
Appendix 3 – Escalation Flowchart - Local Services, Jubilee Ward
Appendix 4 – Escalation Flowchart - Local Services, The Limes
Appendix 5 – Escalation Flowchart - Local Services, H&F
Appendix 6 – Escalation Flowchart - Local Services, Ealing
Appendix 7 – Escalation Flowchart - Local Services, Hounslow
Appendix 8 – Escalation Flowchart - Local Services, Homeward, Magnolia
Appendix 9 – Escalation Flowchart - High Secure Services, Broadmoor Hospital
Appendix 10 - Guidance for use of NEWS in ECT
Appendix 11 – Escalation Flowchart – West London Forensic Services

Appendix 1
NEWS OBSERVATION CHART – front page

Appendix 2
NEWS OBSERVATION CHART INSTRUCTION- back page
National early warning score (NEWS) threshold and triggers
Scores Clinical Risk

0
LOW
Total 1- 4
Individual parameter scoring 3
Medium
Total 5-6
Total 7 or more High
Complete NEWS Chart
NEWS score of 5 or
NEWS score of 1 - 4 more or 3 in one NEWS score of 7 or
parameter more
Clinical risk:
LOW Clinical risk: Clinical risk:
MEDIUM HIGH
Inform Nurse in Charge Inform Nurse in Charge  Escalate immediately to

crash team or accident
Registered Nurse to decide if Registered Nurse to escalate and emergency via
increased frequency of to doctor. Doctor to see patient ambulance service (see
monitoring and/or escalation of within 30 minutes local escalation
clinical care is required protocols)
Frequency of monitoring
Frequency of monitoring Minimum 1 hourly Registered Nurse to
4-6 hourly immediately inform the
medical team caring for the
patient.
Clinical priority safe transfer
Document action in notes


Appendix 3
Escalation Flowchart – Local Services, Jubilee Ward
Complete NEWS Chart
NEWS score of 1 - 4 NEWS score of 5 or NEWS score of 7 or

more or 3 in one more
Clinical risk: parameter Clinical risk:
LOW Clinical risk: HIGH
MEDIUM

accident and emergency
Registered Nurse to decide if Registered Nurse to escalate via ambulance service
increased frequency of to doctor. Doctor to see patient (see local escalation
monitoring and/or escalation of within 30 minutes protocols *)
clinical care is required 
Frequency of monitoring Registered Nurse to
Frequency of monitoring Minimum 1 hourly immediately inform the
4-6 hourly medical team caring for
the patient.
transfer

*Local escalation protocol: Call emergency services on ex 2222. Stop any activity and rest. Remain with
patient. Prepare relevant information for A&E staff – medial history, current medication, latest bloods.
Inform family. Complete IR1.

Appendix 4
Escalation Flowchart – Local Services, The Limes
Complete NEWS Chart

MEDIUM

monitoring and/or escalation of within 30 minutes protocols)
the patient.
transfer

patient. Prepare relevant information for A&E staff – medial history, current medication, NEWS chart, latest
bloods. Inform family. Complete IR1.

Appendix 5
Escalation Flowchart – Local Services, H&F

MEDIUM

the patient.
transfer


Appendix 6
Escalation Flowchart – Local Services, Ealing

MEDIUM

Registered Nurse to escalate accident and emergency
Registered Nurse to decide if to doctor. Doctor to see patient via ambulance service
increased frequency of within 30 minutes (see local escalation
monitoring and/or escalation of protocols *)
Frequency of monitoring
Minimum 1 hourly Registered Nurse to
Frequency of monitoring immediately inform the
the patient.
transfer


Appendix 7
Escalation Flowchart – Local Services, Hounslow

MEDIUM

the patient.
transfer


Appendix 8
Escalation Flowchart – Local Services, Homeward & Magnolia
Inform registered nurse If concerned about the

who MUST assess the patient escalate to
patient without delay. appropriate clinician
Registered nurse to decide Inform the lead clinician
TOTAL of any deterioration
Minimum 4 if increased frequency of
hourly monitoring and/or
1-4
escalation of clinical care is
required, taking into
account patient’s usual
baseline.
If on site, Advanced
Clinical Assessor or
doctor to assess patient.
If above not available,

registered nurse in
Registered nurse to seek charge to discuss
urgent advice: patient’s condition with
Home ward doctor or
Assessment by a clinician
OOH doctor
with core competencies to
Total Increased assess acutely ill patients; (Home ward doctor via
5 or 6 frequency to and decide if patient can
020 8354 8354 / OOH
or 3 in one minimum 1 still be managed safely
parameter hourly within community hospital. doctor: Primary care
advice (LCW) via 0300
Clinical care in an 0333444 (option 2) or On-
environment where call SpR / Physician
observations can be (CWFT) via 020 3315
regularly maintained 8000) as per ward
escalation protocol
Appropriate pathway for

transfer to secondary
care will be considered
Must inform the senior Wherever possible inform

clinician – this may be the receiving emergency
doctor or advanced nurse department of patients’
practitioner clinical history
Total Continuous
7 monitoring of Arrange transfer to Contact next of kin at
or more vital signs Emergency Department via earliest opportunity
LAS (999)
Complete IR1 to document

transfer
Appendix 9
Escalation Flowchart – High Secure Services, Broadmoor Hospital
NEWS Score Frequency of Monitoring Clinical Response
0 As per Guidance for use of NEWS Continue routine physical observations as set
out in the Guidance
Total As determined by the Medical Team Call nurse in charge to assess

1-4 They should assess within 30 mins
Plan of care recorded
Total 5 or more As determined by the Medical Team Call doctor/on-call doctor to attend
or They should assess within 30 mins
3 in one Plan of care recorded
parameter
Total As determined by the Medical Team Seek urgent assistance from ward team and
7 Reassess using the NEWS scoring system
or more Provide BLS as required
Call 222 request urgent doctor/on-call doctor
assistance and ambulance providing a clear
description of the patient’s symptoms and the
NEWS score

Appendix 10
The Adapted National Early Warning Score (NEWS) threshold and triggers for ECT
NEWS Score Frequency of Monitoring Clinical Response
0 As per Guidance for use of NEWS in Continue routine physical observations as set
ECT (see above) out in the Guidance for use of NEWS in ECT
(see above)
Total As determined by the Medical Team Registered Nurse to assess service user
1-4
Nursing team to discuss with Anaesthetist if
review is required
For inpatient service users, ensure that ward

team notified of score and any recommended
action by Medical Team in the ECT department.
For outpatient service users, the ECT

Specialist Nurse / Lead should discuss with the
Medical Team in the ECT department, whether
they should notify the service users GP and the
urgency of this.
Total 5 or more As determined by the Medical Team Registered Nurse to immediately inform
Anaesthetist
Or
For inpatient service users, ensure that ward
3 in one team notified of score and any recommended
parameter action by Medical Team in the ECT department.
For outpatient service users, the ECT

Specialist Nurse / Lead should discuss with the
Medical Team in the ECT department, whether
they should notify the service users GP and the
urgency of this.
Total As determined by the Medical Team Registered Nurse to immediately inform

7 Anaesthetist
Or more
If required Call (9)999 call for ambulance to
transfer service user to nearest Acute Hospital
Please refer to appropriate policies for patients who have been newly introduced to
anti-psychotics.

Appendix 11
Escalation Flowchart – West London Forensic Services

Clinical risk: parameter
LOW Clinical risk:
Clinical risk: HIGH
MEDIUM
Inform Nurse in Charge Inform Nurse in Charge Escalate immediately to

Registered Nurse to via ambulance service
decide if increased Registered Nurse to (see local escalation
frequency of monitoring escalate to doctor. Doctor protocols *)
and/or escalation of to see patient within 30
clinical care is required minutes Registered Nurse to
immediately inform the
Frequency of medical team caring for
monitoring the patient.
Frequency of Clinical priority safe
4-6 hourly
monitoring transfer
Minimum 1 hourly

patient. Prepare relevant information for A&E staff – medical history, current medication, latest bloods.

19. References
1
Hennekens CH, Hennekens AR, Hollar D et al (2005). Schizophrenia and increased risks of cardiovascular disease.
Am Heart J 150:6:1115–1121
2
National Institute for Health and Clinical Excellence (2009) Schizophrenia: Core Interventions for the treatment and
Management of Schizophrenia in Primary and Secondary Care (Update).NICE, London.
https://www.nice.org.uk/guidance/cg82
Accessed 17th July 2016
3
Osborn DPJ, King MN, Nazareth I (2006). Risk of cardiovascular disease in people with SMI: across sectional
comparative study in primary care. Br J Psychiatry 188: 271-277.
4
Rethink (2013) Lethal Discrimination: Why People with Mental Illness are Dying Needlessly and What Needs to
Change. Rethink, London
5
Department of Health (2012) No Health Without Mental Health: A Guide for Clinical Commissioning Groups.
Department of Health, London
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/216870/No-Health-Without-Mental-
Health-Implementation-Framework-Report-accessible-version.pdf
6
Disability Rights Commission (2006) Equal Treatment-Closing The Gap: A Formal Investigation into the Physical
Health Inequalities Experienced by People with Learning Disabilities and Mental Health Problems. DRC, London
7
Royal College of Psychiatrists (2013a). Lester UK Positive Cardiometabolic Health Resource. Adapted from Curtis
J, Newall H, Samaras K. © HETI 2011. Royal College of Psychiatrists, London.
https://www.rcpsych.ac.uk/.../RCP_11049_ Positive%20Cardiometabolic%20Health%20chart-%20website.pdf
8
McCreadie R (2003). Diet, smoking and cardiovascular risk in people with schizophrenia: descriptive study. Br J
Psychiatry 183: 534–539
9
Royal College of Psychiatrists (2012). Report of the National Audit of Schizophrenia (NAS) 2012. Royal College of
Psychiatrists, London.
www.rcpsych.ac.uk/pdf/nas%20national%20report%20final.pdf
10
Osborn D P J (2001). The poor physical health people with mental illness. West J Med: 175: 329-332.
11
Royal College of Psychiatrists (2013b). Improving physical healthcare for people with mental illness: what can be
done? Royal College of Psychiatrists, London
www.rcpsych.ac.uk/pdf/FR%20GAP%2001-%20final2013.pdf
12
Sin J, Bonner G (2010). Promotion of physical wellbeing in schizophrenia and psychosis: implications for NHS
Trusts. British Journal of Wellbeing: 1:2: 31-35
13
Ratcliffe T, Dabin S, Barker P (2011). Physical healthcare for people with serious mental illness. Clinical
Governance: An International Journal 16:1: 20–28
14
National Early Warning Score Development and Implementation Group (NEWSDIG) (2012). National Early
Warning Score (NEWS): standardising the assessment of acute-illness severity in the NHS. London: Royal College of
Physicians. ISBN 978-1-86016-471-2
https://www.rcplondon.ac.uk/projects/outputs/national-early-warning-score-news


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M15p National Early Warning Score NEWS

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Procedure: M15p

National Early Warning Score

Approved by: Quality Matters Committee

Date approved: 6th September 2016

Title of Author: Nurse Consultant Physical Healthcare

Responsible ED: Medical Director

Date issued: 19th April 2018

Review date: September 2019

Target audience: All clinical staff trust-wide

Disclosure Status (B) B Can be disclosed to patients and the public

The Trust aspires to:

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Version Date Title of Author Status Comment

0.01 Sept 10 Lynne Read, Assistant Draft Revised to incorporate comments. To

0.01 Oct 10 Lynne Read, Assistant Final Draft To be approved as a working

0.01 Dec 10 Dr A Cohen, Director of Final Draft For debate/discussion at CSSC

0.02 Jan 12 Director of Primary Care Reviewed Ratified by CEC

03 April 15 Director of Primary Care Review Approved at May CEC.

Sept 15 Reviewed Minor amendments throughout

04 July 16 Nurse consultant Reviewed and Changes to escalation process to bring

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Appendix 1 - NEWS observation chart– front page…………………………………………..15

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Complete NEWS Chart

Document action in notes. Complete IR1 if transferred

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 Identifies trends in patient observations;

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 To facilitate timely recognition of the patients with established or impending

5.6 Use of a NATIONAL Early Warning Scoring system can also:

 Improve the quality of patient observation and monitoring

6 Systems and recording

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6.2.6 Rapid tranquilisation:

6.2.7 Zuclopenthixol Acetate Administration:

6.4 Guidance for use of NEWS in ECT

Patients undergoing ECT treatment - please see Appendix 10

6.4.1 Undertake Physical Observations and NEW Score:

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6.4.2 In acknowledgement that a service user’s physical observations are likely to be

 Prior to each ECT treatment

6.5 Reviewing NEWS

6.7 Service user refusal

7 Recognising a physically deteriorating patient

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West London Mental Health NHS Trust Page 10 of 26

11 Trigger scores - definitions

11.3 A high score is NEWS of 7 or above

12 How to respond to news

N.B. A failure to attend a NEWS call within an acceptable timescale (<30

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 NEWS training will be mandatory for registered nursing staff and

14.3 Using the NEWS observation chart

14.4 The NEWS educational tool

15 Monitoring & audit

17 Glossary of Terms / Acronyms

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West London Mental Health NHS Trust Page 14 of 26

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NEWS OBSERVATION CHART INSTRUCTION- back page

National early warning score (NEWS) threshold and triggers

Scores Clinical Risk

Total 7 or more High

Complete NEWS Chart