Lets talks NEWS...

Nurse and carer worry, I like to think that Critical Care outreach teams take this very seriously and that the 'worry' has a heavy influence in our management.  Many of our patients may score 0, but warrant a trip to the ITU (AKI patients for instance).

However, as part of our escalation policy it states that staff should alert the doctor and or the Outreach team when NEWS is 5 or 3 in one parameter.  This causes the 'radar referral effect'.  We often have a group of these patients on our list.  Personally, I find them difficult to prioritise as they are often receiving frequent observations and have a plan.  By concentrating on this group and make sure they have everything in place can take time, but... what about those not scoring in this threshold?  Do they get pushed to the bottom of the list?  Should nurses follow this protocol to safeguard themselves as well as the patient or are we not looking for sick patients in the right place?

Don't get me wrong,  the NEWS has been revolutionary in the way we deal with deterioration, but as a tool to prioritise this may not be the case. 

There are softer signs at play here....has anyone got any solutions to deal with the 'radar referals'

Lots to discuss @Ron Daniels @Emma Richardson @LIz Staveacre @Danielle Haupt @Kirsty Wood 

I agree Claire, it becomes extremely difficult to screen those patients that have high NEWS but are stable with a plan and those that may not fit into certain categories that are at great risk of deterioration.

Part of the reason, I think, is because of the high quantity of patients that score NEWS throughout the day, and nursing staff feel they need to alert CCOT for majority of them, not because they are worried necessarily but because it says in the policy and they are worried that if they don't they will be held responsible.

In turn, we are conditioning the nursing population to move away from using nursing intuition and losing the confidence to make clinical decisions. In some ways, they are relying on electronic systems to tell them what to do with their patients instead of their nursing experience and knowledge kicking in.

We are receiving more and more referrals where staff members don't really know why they are referring, just that the 'policy says so'. And we are seeing less conversations where staff are aware of their patients scoring, have assessed the patient themselves, had a medic review them and are happy that there is a plan in place.

Whether this is the new generation of nurses we are seeing, or due to the transition to electronic systems/ devices, the fear of litigation or the lack of time for nursing staff to care for their sick patients.

We provide training about the CCOT and all aspects deteriorating patients varying from nursing students, medical students and all grades which should off set some of the difficulties. Despite this, the route of the problem is still unknown and so I do not have any magical solutions. Sorry.

Would love to find out if anyone else is having similar experiences and/or if anyone has any suggestions to help?

Hi Alison, definitely a discussion for you to contribute to! @alisonleary And Elaine Maxwell too.

Helen