National Institute for Health and Clinical Excellence (NICE)
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Calls for standardised model of bedside monitoring

Bedside monitoring for hospital patients should be standardised and based on measures recommended by NICE, according to a new report.

Currently, every acute hospital bed has a chart used to record clinical measurements to decide how severe a patient's illness is or whether they need more urgent care.

However, the charts currently used by NHS Trusts vary and have differing early warning systems. This can lead to inconsistency in the detection and response to acutely ill patients.

For example, in 2009 there were 11,859 preventable deaths in acute hospitals in England, 31.3% of which were caused by poor clinical monitoring.

Authors of a report published last week by the Royal College of Physicians, suggest around 50% of these deaths could have been prevented if a standardised scoring system for monitoring patients was used.

The report proposes introducing a National Early Warning Score (NEWS) for determining patient health, which is based on six measures originally recommended by NICE.

The measurements, as outlined in NICE's guideline on Acutely ill patients in hospital, are for heart rate, respiratory rate, systolic blood pressure, level of consciousness, oxygen saturation, and temperature.

These measurements are already undertaken when patients present to hospitals or are being monitored. NICE recommends they should be taken as a minimum at initial assessment and as part of routine monitoring.

The guideline says that the aggregate scores should be used to trigger a graded response strategy that should be used to identify patients who are at risk of clinical deterioration.

Responses should vary depending on risk score. For example, those with low-risk scores should be observed by nurses more frequently, while a high-risk score should trigger an emergency call out.

The new report suggests a similar graded response strategy, with triggers determining the urgency of the clinical response, and the clinical competency of those responding.

A spokesperson for the Royal College of Physicians said: "The working party agreed with the pragmatic recommendations of the NICE report with regard to the physiological parameters to be included in the NEWS.

"The parameters are all readily measured in patients, either in the pre-hospital or hospital setting, and can be repeatedly measured to document trends and assess changes in illness severity."

Janet Davies, Director of Nursing and service delivery at the RCN, added: "There is nothing nurses and doctors should prioritise more than patient safety, and this system, if implemented across the board, will be a great leap forward for patient care.

"Excellent systems for recognising patient deterioration do exist in many care settings, and have undoubtedly saved many lives.

"However this is the first time clinical expertise and experience have come together to standardise the best of that practice."

The report says the system should not be applied to the care of children, pregnant women, and care should be taken when applying it to certain patients with chronic obstructive pulmonary disease, as this condition could affect the sensitivity of the score.

A range of implementation tools have been produced to help support the use of this guideline. These include implementation advice, costing tools and an electronic audit tool.

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