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      Distribution of the National Early Warning Score (NEWS) in care home residents

      brief-report

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          Abstract

          Background

          the National Early Warning Score (NEWS) is a tool based on vital signs that aims to standardise detection of, and response to, clinical deterioration in adults. NEWS has been adopted in hospitals but not adapted for other settings. This study aimed to explore the feasibility of measuring the NEWS in care homes and describe the distribution of NEWS readings amongst care home residents.

          Methods

          descriptive analysis of all NEWS readings recorded in a 30-month period (2016–19) across 46 care homes in one Clinical Commissioning Group in England. Comparisons were made between measurements taken as a routine reading and those prompted by concern about acute illness.

          Results

          a total of 19,604 NEWS were recorded from 2,424 older adults (≥65 years; mean age 85). Median NEWS was 2. Two thirds (66%) of residents had a low NEWS (≤2), and 28% had a score of 0. Of the total NEWS readings, 6,277 (32%) were known to be routine readings and 2,256 (12%) were measured because of staff concerns. Median NEWS was 1 for routine and 2 for concern recordings. Overall, only 12% of NEWS were high (≥5), but a higher proportion were elevated when there were concerns about acute illness (18%), compared with routine recordings (7%).

          Conclusions

          use of NEWS in care homes appears to be feasible. The majority of NEWS were not elevated, and the distribution of scores is consistent with other out-of-hospital settings. Further work is required to know if NEWS is triggering the most appropriate response and improving care home resident outcomes.

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          Strengths and limitations of early warning scores: A systematic review and narrative synthesis

          C.L. Downey, W. Tahir, R Randell … (2017)
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            Can early warning scores identify deteriorating patients in pre-hospital settings? A systematic review

            Rita Patel, Manjula D Nugawela, Hannah B Edwards … (2018)
            To evaluate the effectiveness and predictive accuracy of early warning scores (EWS) to predict deteriorating patients in pre-hospital settings.
            Article 0 comments Cited 46 times – based on 0 reviews     Review now
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              Who Lives Where and Does It Matter? Changes in the Health Profiles of Older People Living in Long Term Care and the Community over Two Decades in a High Income Country

              Fiona Matthews, Holly Bennett, Raphael Wittenberg … (2016)
              Background There have been fundamental shifts in the attitude towards, access to and nature of long term care in high income countries. The proportion and profile of the older population living in such settings varies according to social, cultural, and economic characteristics as well as governmental policies. Changes in the profiles of people in different settings are important for policy makers and care providers. Although details will differ, how change occurs across time is important to all, including lower and middle income countries developing policies themselves. Here change is examined across two decades in England. Methods and Findings Using the two Cognitive Function and Ageing Studies (CFAS I: 77% response, CFAS II: 56% response), two population based studies of older people carried out in the same areas conducted two decades apart, the study diagnosis of dementia using the Automated Geriatric Examination for Computer Assisted Taxonomy, health and wellbeing were examined, focusing on long term care. The proportion of individuals with three or more health conditions increased for everyone living in long term care between CFAS I (47.6%, 95% CI: 42.3–53.1) and CFAS II (62.7%, 95% CI: 54.8–70.0) and was consistently higher in those without dementia compared to those with dementia in both studies. Functional impairment measured by activities of daily living increased in assisted living facilities from 48% (95% CI: 44%-52%) to 67% (95% CI: 62%-71%). Conclusions Health profiles of residents in long term care have changed dramatically over time. Dementia prevalence and reporting multiple health conditions have increased. Receiving care in the community puts pressure on unpaid carers and formal services; these results have implications for policies about supporting people at home as well as for service provision within long term care including quality of care, health management, cost, and the development of a skilled, caring, and informed workforce.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Age Ageing
                Journal ID (iso-abbrev): Age Ageing
                Journal ID (publisher-id): ageing
                Title: Age and Ageing
                Publisher: Oxford University Press
                ISSN (Print): 0002-0729
                ISSN (Electronic): 1468-2834
                Publication date (Print): January 2020
                Publication date (Electronic): 09 December 2019
                Publication date PMC-release: 09 December 2019
                Volume: 49
                Issue: 1
                Pages: 141-145
                Affiliations
                [1 ] Population Health Sciences Institute , Newcastle University
                [2 ] Academic Health Science Network North East and North Cumbria
                Author notes
                Address correspondence to Robert Oliver Barker, Institute of Health & Society, Newcastle University, Level 2, Newcastle Biomedical Research Building Campus for Ageing and Vitality, Newcastle upon Tyne NE4 5PL, UK. Tel: (+44) 019 120 83648. Email: robert.barker@ 123456newcastle.ac.uk
                Article
                Publisher ID: afz130
                DOI: 10.1093/ageing/afz130
                PMC ID: 6911654
                PubMed ID: 31813952
                SO-VID: 6436b880-3407-4cd6-988b-c3b52a702900
                Copyright © © The Author(s) 2019. Published by Oxford University Press on behalf of the British Geriatrics Society.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

                History
                Date received : 16 May 2019
                Date revision requested : 20 August 2019
                Page count
                Pages: 5
                Categories
                Subject: Short Report

                ScienceOpen disciplines: Geriatric medicine
                Keywords: care homes,track and trigger systems,national early warning score,older people
                Data availability:
                ScienceOpen disciplines: Geriatric medicine
                Keywords: care homes, track and trigger systems, national early warning score, older people

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