This paper seeks to find out and elaborate the term Early Warning Scores (EWS) while also showing its vital role in early identification and quick treatment of a patient who is experiencing a fast deterioration of health. There are other diverse scores that are similar to the Early Warning Score (EWS). For example, there is the ‘Modified Early Warning Score’ and the ‘National Early Warning Score’. The above scores have different terms because they use different set of parameters and variables in measurement when compared to the EWS. This paper will focus on the use of EWS consistently and will only refer to measurements that fall under EWS.

Literature mainly drawn from national policies and guidelines issued by bodies such as the National Institute of Clinical Excellence (NICE), National Confidential Inquiry into Patient Outcome and Death (NCEPOD), and National Patient Safety Agency (NPSA) reinforce our support of the use and efficacy of EWS. Through the use of literature derived from medical books nursing journal, medical journals, and other medical sources from the internet we will provide evidence on the efficacy and use of EWS. The objective will be to come up with a recommendation on the EWS that is derived from research.

The first consideration when discussing critical care is to consider what it comprises of. Critical care is the direct delivery of medical-care to the patients that are acutely ill. While giving critical care it should be understood that critically ill patients require skilled nursing and superior medical inputs in the realm of physiology as well as psychology (Skills for Health, 2011). Most cancer patients fall in the category of critically ill patients. Carl et al, (2000) states that the UK does not have an impressive record in this respect, he states “The picture is far from clear, with the UK having much worse survival rates from many forms of cancer than either the US or many European countries. Differences such as these are likely to be caused by a range of factors in addition to the quality of healthcare provided, such as incomes, education levels climates and cultural influences”. According to the UCD, (2010) treatment is seen to be the set of activities which are about taking care and deal well with the interests of the person suffering from an illness. In accordance to the Assembly of European Regions, (2010), EWS would take the meaning of a score worked on to give a prediction of the real or a likeliness of the issue while still in its initial stages by checking for the presence of a disease in the patient. EWS allows for contributions that lead to action and involvement to hinder advancement of a sickness at the very early stage.

To begin with, we are pleased to give forth the good news i.e. NICE guidelines (2007) which affirm the EWS to have been in a wide and great use on the patients who are verging on a state of crisis in the UK hospitals. A research which was undertaken by Griffiths and Kidney (2011) in the health facilities of the UK showed that many of those who replied approved the making use of the EWS and also found it to be a remedy for those patients in crisis of their health. Roberts and Smith (2011) announced that the very first EWS to be put into use was built at the James Padgett Hospital in the Great Yarmouth and the health care facilities in the UK have been using the EWS ever since. Morgan et al (1997)were the first people to carry out a researchand produce a printed document on the EWS in the UK to be used as a device for early determination of the existence of a disease in a patient and to curb it so that patients would be given timely treatment care and interventions. Documents like the Morgan et al (1997) and the rest that came later in time gave an account of unwarranted detains in the vital care of patients on the part of the nursing and medical staff. The EWS came for use as means and medical process in the UK (Johnstone et al 2007). More affirming of the roles of the EWS is by the Carberry (2002) where he says that EWS was introduced to medical exercise for the nurses and the medical staff. It entailed getting the facts of the actual situation after carrying out several tests on the patient. In keeping with Subbe et al (2001), the EWS is easy process to make use of and is carried out just besides the patient’s bed. Subbe et al (2001) goes on to reveal that the EWS is an uncomplicated operation and entails five critical readings of the patient’s condition i.e. the temperature, heart rate, respiratory rate, level of consciousness and the systolic blood pressure. Roberts (2008) affirms the workability of the EWS and believes that that it is a device for early discovery and detection of likelihood of vital sickness or fall of the medical state of the patient. Likewise, Luettel et al (2007) says that the EWS best use is in detection of initial signs of the fall of a patient’s health status in order to allow for timely medication.

The EWS should be put to use by the trained and well versed in its use medical staff. Having noticed that, the NICE guideline (2007) advocates for the reading and interpretation of the EWS data by the trained and skilled medical staff in a way that at least two readings are obtained daily from the critically ill patients. The two readings could be increased to a bigger number when the medical officer in charge recommends so of a patient whose health status could be fast dropping. More research findings affirm and demonstrate the use of the EWS and its suitability. According to Kyriacos et al (2011), the EWS can be best for the critically sick and admitted patients but enough proof is not available for the patients admitted suffering from common diseases. Although Subbe et al (2003) advocates the EWS to be a tool that measures the possibility of danger in the health of an individual, they eventually join the rest of the researchers to conclude of a serious inefficiency in proving that the EWS can beeffectively used for other patients other than the seriously ill. Subbe et al further recognizes that no investigation for establishing the suitability of the EWS as a device to handle the general medical sudden crisis. Therefore, in as much as most of the research show EWS to be best used in the determination and cure of the seriously sick patients and not for the general illnesses, there is yet other research the like of Twomey et al (2007) which pronounces the measurements like the EWS to be consistent in as much as it may not be proven all valid yet. Goldhill et al (2005) states that a high EWS reading for the patients at the general bring about proper medication and raise the health conditions of the patients.

According to Subbe et al (2003), going to the real measurements of the EWS, attention is then moved to the reality that the respiratory rate is the most responsive in the health condition of the terminally sick patient. Even though, the important indicator is either not observed or the measurements not taken in regularity (NICE, 2007; Kenward et al, 2011; Luettel et al, 2007). This observation is also supported by Hogan (2006), he observed that only in half of his sample did EWS include recordings of the respiratory rate, while in other four it was obtained regularly. Roberts and Smith (2011), and also Kenward et al (2001) advance several reasons for respiratory readings not being obtained regularly under EWS. They attribute the lack of these measurements to a lack of skills in observation staff and over relying on medical machinery which cannot take respiratory readings. This shows that the importance and effectiveness of EWS as depicted by researchers is limited by staff members’ abilities and skills in measuring all the parameters. Research shows that untrained nursing practitioners took respiratory readings in only one third of EWS scores; this improved to 90 per cent after they had received EWS training. This findings show the importance of training medical staff in the use of EWS and also in showing them which measures are vital and how to obtain them.

Other sample based studies and researches have also shown that EWS was not used in almost 30% of the sampled Hospitals; they also revealed that the nursing staff did not recognize critical signals in some cases (Cullinane et al, 2005). Another sampling based research credits EWS and states that the admission of patients into highly critical units where they are kept under constant observation can be prevented by the use of EWS (Chatterjee et al, 2005). The failure to identify critical signals has been attributed to EWS data that is not taken consistently and therefore leading to an illogical EWS score. According to Luettelet al, (2007) legibility of data on paper may affect the reading of EWS. Human handwriting was to blame for the disregard and misreading of the EWS signals (Chatterjee et al, 2005). He further states that compared to values plotted by medical equipment not more than half of handwritten values could be read and interpreted compared to 82% legibility from machine plotted data. This phenomenon was among the various reasons behind the differences in ineffectiveness of EWS in various hospitals. To overcome this document standardization needs to be developed for EWS (Chatterjee et al, 2005). They further argue that standardization will not only ease EWS training but will also help interventions in case of critical patients. Most studies agree that EWS is effective in pointing out vital signals in case of critical patients. They also agree that substantially large and random samples may be required to secure this finding (Subbe et al, 2003; Kyriacos et al, 2011; NICE guidelines, 2007 & Goldhill and McNarry, 2004; Griffiths and Kidney, 2011). Where there are doubts about the accuracy of the EWS scores readings the nursing staff fear the unwarranted intervention caused by erroneous signals; this calls for recalculation of EWS scores (Cuthbertson and Smith,2007; Smith and Oakley’s, 2006). Keepingwith DayandOldroyd (2010) EWS readings may differ according to various factors like air pollution, room temperature and other factors which may affect readings. Errors of judgement may be committed if the medical practitioners do not have the skills in building the extraneous factors that affect EWS readings. Institutions such as NICE and NPSA see EWS as an opportunity to collect and summarize data on critical patients over a period of time and therefore recommend its diligent deployment (Goldhill and McNarry, 2004). We agree with Griffiths and Kidney (2011) views that EWS is a key decision tool for medical and nursing staff in care of critical patients. EWS score cards can be replaced with computerized systems that can help reduce human errors (Smith et al, 2006).

Often EWS scores are accurate indicators and ignoring them may lead to serious consequences. EWS can be made an essential practice since it is simple and easy to calculate and use. Medical staff can be at ease when EWS scores are declining and intervene when the scores climb up. Not acting on high scores may lead to serious consequences (Groarke et al’s, 2008 & Paterson et al, 2006). Identifying criticality of patients is an involving process that requires successful communication and coordination between the nursing branch and the medical staff. EWS can help contribute to this communication as well as draw contribution from other staff such as junior surgeons while setting priorities on all categories of critical patients (Gardner- Thorpe et al, 2006).

EWS has been observed widely accepted in the UK healthcare industry. Concluding major institutions like NICE are seen to find it recommendable. This is so because of its usability overwhelming results in many cases while in sametime the use of the wrong records in calculations can lead to overreactions. To avoid errors as a result of negligence or human error bedside computers are best fit to do these calculations. EWS is just a result collected from a number of patients records. This means that the real action is preserved for the nursing fraternity and the medical sphere. This means the logistics must be improved to enhance skills and experience to ensure a desirable quality provided to the patients as provided for by NMC code (2008).

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