Clinical risk assessment tools
Early Warning Scores
This system grades the regular observations taken by a nurse for a patient in order to classify changes as needing further review. EWS systems differ between trusts, but can have the following key features: Measurements:
- Blood Pressure
- Heart Rate
- Respiratory Rate
- Oxygen Saturation
- Supplemental Oxygen given
- Consciousness level (AVPU)
The obs chart may also list information such as pain scores, urine output, but these do not form part of the EWS criteria
- Each measurement above scores separately
- Add the scores from each section together to get a total EWS score
Action (varies between trusts):
- Document any change in EWS score and action taken
- Low score- increase observations
- Medium score- request opinion of senior nurse/ junior doctor
- High score- request opinion of senior registrar/ consultant.
- Some patients may be well, but chronically score highly on EWS charts (e.g. supplemental oxygen in a COPD patient, or a normally hypotensive, hyperthermic patient)
- Does not include other measurements- LFTs to indicate hepatic decompensation, for example.
- High EWS should not need to be calculated- the patient is patently unwell.
- EWS should not replace clinical judgement- low score does not mean inaction!
For patients with Pneumonia:
- Urea > 7 mmol/L
- Respiratory Rate >=30/min
- Blood Pressure <90 sys +/- <60 dia.
- 65 years of age or greater.
- 0-1- Low Risk- community management
- 2-3- Mid Risk- Short inpatient admission
- 4-5 High Risk- Prolonged admission, critical care may be needed