Early Warning Scores
D’s NEWS2 score was calculated after he’d been in the department for 4 and a half hours; 2 hours and 35 minutes after receiving midazolam. It was 9.
LeDeR2 found that, in many cases, people with a learning disability did not have a complete NEWS2 score calculated in the run-up to their death and, when it was calculated, it was not acted upon. There are probably lots of reasons for this, including clinical staff not wanting to distress a person by measuring their blood pressure, for example, or assuming that a high score is “normal for them”. As discussed earlier, reasonable adjustments might be needed to enable the person to tolerate having observations taken, including letting them get used to equipment, using distraction, or demonstrating it on someone else, for example.
It’s important to think about what the person’s EWS might be when they are well. It’s actually not very common to have a high score when well. It’s more common to have a low score and yet be very unwell. Someone with an underlying neurological condition may not be able to mount a fever or tachycardia in response to illness, or sustain increased work of breathing, for example, so their NEWS2 or PEWS may be falsely low or normal.