Background Following a clinical incident there was a review of the current system for recording and reporting patient observations. This involved an initial audit of current practice and scoping of regional and national practice.
Aims The project aim was to provide all clinical staff with a tool to identify critically unwell patients and respond safely and appropriately.
Methods The project team looked at the local hospitals NEWS (National Early Warning Score) charts and embarked on designing a bespoke chart for the hospice setting. Following several rounds of consultation and different iterations it happened that the NEWS 2 (Royal College of Physicians. National Early Warning Score (NEWS) 2, 2017) tool was released nationally. This led to further review and highlighted our error in trying to adapt a nationally recognised tool which was enabling common language, transferability and standardisation across different settings.
Results Following cascade training to all clinical staff, NEWS 2 is now embedded in use in the Inpatient Unit. Staff have said it ‘highlights when we should respond to triggers’ and it ‘helps decision making overnight and when the medical on call needs to be contacted’. Weekly snapshot audits have also shown examples of clearer documentation regarding planned frequency of observation and clinical response and allowed assessment and teaching at the point of care. A more formal audit is being undertaken in June 2019 and the results of this will also be reported.
Conclusion Despite some initial resistance to change we have shown that it has been possible and acceptable to introduce the use of NEWS 2 in the hospice inpatient setting. Following this it is now being rolled out to other departments including Day Services and the Clinical Nurse Specialist Team.