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Clinical risk assessment tools

From Mediwikis

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
  • Temperature
  • 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
Scoring:

  • 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.

Limitations

  • 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!

CURB-65

For patients with Pneumonia:

  • Confusion
  • Urea > 7 mmol/L
  • Respiratory Rate >=30/min
  • Blood Pressure <90 sys +/- <60 dia.
  • 65 years of age or greater.

CURB-65 score:

  • 0-1- Low Risk- community management
  • 2-3- Mid Risk- Short inpatient admission
  • 4-5 High Risk- Prolonged admission, critical care may be needed