Standardising the management of acute deterioration (WHC/2024/035)

Status:

Action.

Category:

Quality and safety.

Title:

Standardising the management of acute deterioration.

Date of expiry / review:

Non-applicable.

Action by:

Local health boards and NHS trusts, primary care providers.

For information:

• Health Education and Improvement Wales (HEIW).
• Healthcare Inspectorate Wales (HIW), NHS Wales Executive.

Required by:

Immediate.

Sender:

Professor Pushpinder Mangat, Deputy Chief Medical Officer, Health Services.
Professor Sue Tranka, Chief Nursing Officer, Nurse Director NHS Wales.

Welsh Government contacts:

Tom Warren,
Quality and Safety,
Quality and Nursing Directorate.
Tel: 03000 258109
Email: QualityAndNursing@gov.wales

Enclosures:

None.

Dear colleagues,

This Welsh health circular sets out our expectations in relation to standardising the management of acute deterioration.

Standardising the management of acute deterioration

We are pleased to inform you that following extensive engagement with stakeholders, the NHS Wales Executive has finalised agreement on the standardisation of Early Warning Scores (EWS) across Wales.

Early warning scores

EWS function to identify acute deterioration, to suggest a point at which care needs to be escalated and to define a response to escalation triggers. Current practice varies, with potential risks to patient safety. A standardised, national approach using evidence-based tools will ensure clarity, minimise risk and support improved patient outcomes.

It has now been agreed, following a wide consultation process with a large number of stakeholders which tools should be used for respective areas across Wales:

1. NEWS2 (and subsequent updates) 
   Should be used for the identification and escalation of acute deterioration in adults in Wales.
2. National PEWS (and subsequent updates) 
   Should be used for children and young people in Wales.
3. NEWTT2 (and subsequent updates) 
   Should be adopted for the identification and escalation of acute deterioration in neonates.

A nationally agreed EWS for maternity will be finalised in October 2024.

Adoption of NEWS2, National PEWS and NEWTT2 tools in Wales will ensure alignment with England. As tools are updated, it is expected that newer versions will be utilised as they are published.

Organisations are expected to implement the use of the recommended EWS tools outlined above. The transition to the recommended EWS will require training for staff, and existing NHS England e-learning packages for NEWS2, National PEWS and NEWTT2 will be added to ESR for NHS Wales staff.

The NHS Executive will establish an implementation network that will provide intensive supportive leadership and oversight of the implementation programme. Organisations will not be required to fund any new posts for the implementation of the recommended EWS although it is expected they will allow teams the time to work with the NHS Executive and the implementation network to ensure improvements and adoption of the standardised tools noted above. It is important that organisations fully develop their deteriorating patient pathways which includes the integration of these tools into effective response systems, and where appropriate responses to the escalation of patients’ needs are supported by good governance, leadership and oversight.

The NHS Wales Executive will work with health boards and trusts on implementation, providing guidance and strategic support, as well as monitoring progress and providing national updates to Welsh Government. Local updates will be provided through integrated quality, planning and delivery meetings.

We would like to thank all the stakeholders involved in this comprehensive work which is an important step in improving patient safety and delivering the highest quality of care for the people of Wales.

Yours sincerely,

Professor Pushpinder Mangat.

Professor Sue Tranka.