Page 141 - Hospital Authority Convention 2017

Service Enhancement Presentations

F4.2 Clinical Safety and Quality Service II 16:15 Room 421

The Implementation of an Integrated Observation Chart with Newborn Early Warning Signs to Facilitate Early
Observation of Infants at Risk of Clinical Deterioration
Chan MY, Shek CC, Kwong T, Lee M, Liu HL HOSPITAL AUTHORITY CONVENTION 2017
Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, Hong Kong

Introduction
Different observation charts were used in Special Care Baby Unit (SCBU) of Princess Margaret Hospital (PMH), with no
reference range of significant clinical signs for screening at-risk infants. This hindered early recognition of infant’s clinical
deterioration and effective team communication, as well as taking appropriate interventions promptly.

Objectives
(1) To develop an Integrated Observation Chart with Newborn Early Warning Signs (NEWS) to identify infant’s clinical
deterioration for taking appropriate interventions in SCBU; and (2) to evaluate its discrimination ability in screening infant for
Neonatal Intensive Care Unit (NICU) admission.

Methodology
A retrospective chart review diagnostic study was conducted in SCBU of PMH. All infants transferred from SCBU to NICU for
step-up care and matched controls without NICU admission from February 2015 to January 2016 were recruited. A draft of
NEWS was developed by an expert panel including neonatologist and neonatal nurses. Subjects were divided into training
(70%) and testing set (30%) for chart modification and testing respectively. The modified versions were discussed by the
panel to develop the finalised versions of NEWS.
Results Tuesday, 16 May
108 infants were recruited (64 males, mean age: 0.79 ± 2.96 days), 36 were transferred to NICU. NEWS included temperature,
abdominal distention, cardiovascular, respiratory, neurological and physiological status. Three colour zones indicated
consultation urgency, where red showing the need for immediate consultation. The sensitivity and specificity were 80.6%
(95%CI: 65.0%-90.3%) and 90.3% (95%CI: 81.3%-95.2%) respectively.

NEWS could facilitate early identification of infant’s clinical deterioration and provide guidance for nurses to initiate
appropriate intervention to improve patient outcome.

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