Clinical Observations

Total NEWS 2 Score, Sub-Scores and Observations Bundle Example

Scenario

Background

Mr Smith is 52-year-old gentleman who attends the Emergency Department of his local hospital with a fever, cough and pleuritic pain with following vitals:

Respiratory rate: 21/min
Oxygen saturation : 93%
On air
Systolic blood pressure: 120 mmHg
Heart rate : 95/min
Consciousness: Alert
Temperature: 37.5 C

These observed vitals are each allocated a score, as they are measured. This forms the basis of the NEWS 2 scoring system, with the magnitude of the score reflecting how extremely these vitals varies from the norm. The score is then aggregated. Mr Smith's vitals are recorded as a NEWS 2 score of 6. Since this is a NEWS 2 score of 5 or more, this is the trigger level for an urgent clinical response. The Emergency Department Consultant, Dr Paul Rastall, who is responsible for Mr Smith's care, ensures that the appropriate medical intervention is made as this NEWS 2 score is a strong indicator of increased risk of serious clinical deterioration and mortality in patient with acute medical illnesses.

In this scenario the total NEWS 2 Score, sub-scores and vital signs observations are recorded.

Named Participants

Patient: Mr William Smith - Patient Resource
Emergency Department Consultant: Dr Paul Rastall - Practitioner Resource

Named Organizations:

Hospital: Anytown Royal Infirmary - Organization Resource

Example

<meta>

</meta>

<entry>

<fullUrl value="Observation/21344a45-2660-45d1-9fb3-49e54d14b662" />
<resource>
<Observation>
<id value="21344a45-2660-45d1-9fb3-49e54d14b662" />
<identifier>
<system value="https://tools.ietf.org/html/rfc4122" />
<value value="7188c7ad-7802-4d43-9775-4d9d684600d5" />
</identifier>
<status value="final" />
<category>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/observation-category" />
<code value="survey" />
<display value="Survey" />
</coding>
</category>
<code>
<coding>
<system value="http://snomed.info/sct" />
<code value="1104051000000101" />
<display value="Royal College of Physicians NEWS2 (National Early Warning Score 2) total score" />
</coding>
</code>
<subject>
<reference value="Patient/ad2c58ab-ffab-4366-9c76-b0322e22e881" />
</subject>
<effectiveDateTime value="2018-10-04T14:17:59+01:00" />
<performer>
<reference value="Practitioner/7096e518-2638-4c00-ab0e-504c20cd50b6" />
</performer>
<performer>
<reference value="Organization/25d5ad55-5657-4cbe-9b8b-2e993f19286e" />
</performer>
<valueQuantity>
<value value="6" />
<unit value="ScoreOf" />
<system value="http://unitsofmeasure.org" />
<code value="{ScoreOf}" />
</valueQuantity>
<derivedFrom>
<reference value="Observation/fc6c6fa5-d8e8-4634-a19a-985325077cb2" />
</derivedFrom>
<derivedFrom>
<reference value="Observation/638c6821-eb51-4f1b-b8c0-5269d1df9b7c" />
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<derivedFrom>
<reference value="Observation/5a1625e8-938e-4c19-9d3e-a235bfb4b37d" />
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<reference value="Observation/c756fd32-f04e-45a9-b02f-2461ed53c736" />
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<derivedFrom>
<reference value="Observation/dbf6ec86-ebd7-4490-8586-596328519ed2" />
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<component>
<code>
<coding>
<system value="http://snomed.info/sct" />
<code value="1104301000000104" />
<display value="Royal College of Physicians NEWS2 (National Early Warning Score 2) - respiration rate score" />
</coding>
</code>
<valueQuantity>
<value value="2" />
<unit value="ScoreOf" />
<system value="http://unitsofmeasure.org" />
<code value="{ScoreOf}" />
</valueQuantity>
</component>
<component>
<code>
<coding>
<system value="http://snomed.info/sct" />
<code value="1104351000000103" />
<display value="Royal College of Physicians NEWS2 (National Early Warning Score 2) - pulse score" />
</coding>
</code>
<valueQuantity>
<value value="1" />
<unit value="ScoreOf" />
<system value="http://unitsofmeasure.org" />
<code value="{ScoreOf}" />
</valueQuantity>
</component>
<component>
<code>
<coding>
<system value="http://snomed.info/sct" />
<code value="1104311000000102" />
<display value="Royal College of Physicians NEWS2 (National Early Warning Score 2) - oxygen saturation scale 1 score" />
</coding>
</code>
<valueQuantity>
<value value="2" />
<unit value="ScoreOf" />
<system value="http://unitsofmeasure.org" />
<code value="{ScoreOf}" />
</valueQuantity>
</component>
<component>
<code>
<coding>
<system value="http://snomed.info/sct" />
<code value="1104331000000105" />
<display value="Royal College of Physicians NEWS2 (National Early Warning Score 2) - air or oxygen score" />
</coding>
</code>
<valueQuantity>
<value value="0" />
<unit value="ScoreOf" />
<system value="http://unitsofmeasure.org" />
<code value="{ScoreOf}" />
</valueQuantity>
</component>
<component>
<code>
<coding>
<system value="http://snomed.info/sct" />
<code value="1104371000000107" />
<display value="Royal College of Physicians NEWS2 (National Early Warning Score 2) - temperature score" />
</coding>
</code>
<valueQuantity>
<value value="1" />
<unit value="ScoreOf" />
<system value="http://unitsofmeasure.org" />
<code value="{ScoreOf}" />
</valueQuantity>
</component>
<component>
<code>
<coding>
<system value="http://snomed.info/sct" />
<code value="1104341000000101" />
<display value="Royal College of Physicians NEWS2 (National Early Warning Score 2) - systolic blood pressure score" />
</coding>
</code>
<valueQuantity>
<value value="0" />
<unit value="ScoreOf" />
<system value="http://unitsofmeasure.org" />
<code value="{ScoreOf}" />
</valueQuantity>
</component>
<component>
<code>
<coding>
<system value="http://snomed.info/sct" />
<code value="1104361000000100" />
<display value="Royal College of Physicians NEWS2 (National Early Warning Score 2) - consciousness score" />
</coding>
</code>
<valueQuantity>
<value value="0" />
<unit value="ScoreOf" />
<system value="http://unitsofmeasure.org" />
<code value="{ScoreOf}" />
</valueQuantity>
</component>
</Observation>
</resource>

</entry>

<entry>

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<value value="2936d52c-5ae3-434b-8978-bfa7563ed31a" />
</identifier>
<status value="final" />
<category>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/observation-category" />
<code value="vital-signs" />
<display value="Vital Signs" />
</coding>
</category>
<code>
<coding>
<system value="http://snomed.info/sct" />
<code value="86290005" />
<display value="Respiratory rate" />
</coding>
<coding>
<system value="http://loinc.org" />
<code value="9279-1" />
<display value="Respiratory Rate" />
</coding>
</code>
<subject>
<reference value="Patient/ad2c58ab-ffab-4366-9c76-b0322e22e881" />
</subject>
<effectiveDateTime value="2018-10-04T14:17:59+01:00" />
<performer>
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<performer>
<reference value="Organization/25d5ad55-5657-4cbe-9b8b-2e993f19286e" />
</performer>
<valueQuantity>
<value value="21" />
<unit value="Breaths / minute" />
<system value="http://unitsofmeasure.org" />
<code value="{Breaths}/min" />
</valueQuantity>
</Observation>
</resource>

</entry>

<entry>

<fullUrl value="Observation/f0d26102-3a50-4993-9203-6089b625fc2f" />
<resource>
<Observation>
<id value="f0d26102-3a50-4993-9203-6089b625fc2f" />
<identifier>
<system value="https://tools.ietf.org/html/rfc4122" />
<value value="99a2f708-66aa-4e7f-a09c-5742600f376d" />
</identifier>
<status value="final" />
<category>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/observation-category" />
<code value="vital-signs" />
<display value="Vital Signs" />
</coding>
</category>
<code>
<coding>
<system value="http://snomed.info/sct" />
<code value="364075005" />
<display value="Heart rate" />
</coding>
<coding>
<system value="http://snomed.info/sct" />
<code value="78564009" />
<display value="Pulse rate" />
<userSelected value="true" />
</coding>
<coding>
<system value="http://loinc.org" />
<code value="8867-4" />
<display value="Heart rate" />
</coding>
</code>
<subject>
<reference value="Patient/ad2c58ab-ffab-4366-9c76-b0322e22e881" />
</subject>
<effectiveDateTime value="2018-10-04T14:17:59+01:00" />
<performer>
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</performer>
<performer>
<reference value="Organization/25d5ad55-5657-4cbe-9b8b-2e993f19286e" />
</performer>
<valueQuantity>
<value value="95" />
<unit value="heart beats per minute" />
<system value="http://unitsofmeasure.org" />
<code value="{beats}/min" />
</valueQuantity>
</Observation>
</resource>

</entry>

<entry>

<fullUrl value="Observation/1a1273f4-dd78-4bb4-bb98-ed6456caa2a2" />
<resource>
<Observation>
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<identifier>
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<value value="de2273eb-ecb0-4205-862e-6a43b8f71ec1" />
</identifier>
<status value="final" />
<category>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/observation-category" />
<code value="vital-signs" />
<display value="Vital Signs" />
</coding>
</category>
<code>
<coding>
<system value="http://snomed.info/sct" />
<code value="103228002" />
<display value="Hemoglobin saturation with oxygen" />
</coding>
<coding>
<system value="http://loinc.org" />
<code value="2708-6" />
<display value="Oxygen saturation in Arterial blood" />
</coding>
</code>
<subject>
<reference value="Patient/ad2c58ab-ffab-4366-9c76-b0322e22e881" />
</subject>
<effectiveDateTime value="2018-10-04T14:17:59+01:00" />
<performer>
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<valueQuantity>
<value value="93" />
<unit value="percent" />
<system value="http://unitsofmeasure.org" />
<code value="%" />
</valueQuantity>
</Observation>
</resource>

</entry>

<entry>

<fullUrl value="Observation/c756fd32-f04e-45a9-b02f-2461ed53c736" />
<resource>
<Observation>
<id value="c756fd32-f04e-45a9-b02f-2461ed53c736" />
<identifier>
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<value value="ce084616-c540-4032-aeb3-ef35347600c5" />
</identifier>
<status value="final" />
<code>
<coding>
<system value="http://snomed.info/sct" />
<code value="722742002" />
<display value="Breathing room air" />
</coding>
</code>
<subject>
<reference value="Patient/ad2c58ab-ffab-4366-9c76-b0322e22e881" />
</subject>
<effectiveDateTime value="2018-10-04T14:17:59+01:00" />
<performer>
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</resource>

</entry>

<entry>

<fullUrl value="Observation/5a1625e8-938e-4c19-9d3e-a235bfb4b37d" />
<resource>
<Observation>
<id value="5a1625e8-938e-4c19-9d3e-a235bfb4b37d" />
<identifier>
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<value value="cff7c586-5a41-403b-a276-fc2cce24bf3b" />
</identifier>
<status value="final" />
<category>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/observation-category" />
<code value="vital-signs" />
<display value="Vital Signs" />
</coding>
</category>
<code>
<coding>
<system value="http://snomed.info/sct" />
<code value="276885007" />
<display value="Core body temperature" />
</coding>
<coding>
<system value="http://loinc.org" />
<code value="8310-5" />
<display value="Body temperature" />
</coding>
</code>
<subject>
<reference value="Patient/ad2c58ab-ffab-4366-9c76-b0322e22e881" />
</subject>
<effectiveDateTime value="2018-10-04T14:17:59+01:00" />
<performer>
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</performer>
<performer>
<reference value="Organization/25d5ad55-5657-4cbe-9b8b-2e993f19286e" />
</performer>
<valueQuantity>
<value value="37.5" />
<unit value="degree Celsius" />
<system value="http://unitsofmeasure.org" />
<code value="Cel" />
</valueQuantity>
</Observation>
</resource>

</entry>

<entry>

<fullUrl value="Observation/638c6821-eb51-4f1b-b8c0-5269d1df9b7c" />
<resource>
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<status value="final" />
<category>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/observation-category" />
<code value="vital-signs" />
<display value="Vital Signs" />
</coding>
</category>
<code>
<coding>
<system value="http://snomed.info/sct" />
<code value="75367002" />
<display value="Blood pressure" />
</coding>
<coding>
<system value="http://loinc.org" />
<code value="85354-9" />
<display value="Blood pressure panel with all children optional" />
</coding>
</code>
<subject>
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</subject>
<effectiveDateTime value="2018-10-04T14:17:59+01:00" />
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<performer>
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<bodySite>
<coding>
<system value="http://snomed.info/sct" />
<code value="368209003" />
<display value="Right upper arm structure" />
</coding>
</bodySite>
<component>
<code>
<coding>
<system value="http://snomed.info/sct" />
<code value="72313002" />
<display value="Systolic arterial pressure" />
</coding>
<coding>
<system value="http://loinc.org" />
<code value="8480-6" />
<display value="Systolic blood pressure" />
</coding>
</code>
<valueQuantity>
<value value="120" />
<unit value="millimeter of mercury" />
<system value="http://unitsofmeasure.org" />
<code value="mm[Hg]" />
</valueQuantity>
</component>
<component>
<code>
<coding>
<system value="http://snomed.info/sct" />
<code value="1091811000000102" />
<display value="Diastolic arterial pressure" />
</coding>
<coding>
<system value="http://loinc.org" />
<code value="8462-4" />
<display value="Diastolic blood pressure" />
</coding>
</code>
<valueQuantity>
<value value="60" />
<unit value="millimeter of mercury" />
<system value="http://unitsofmeasure.org" />
<code value="mm[Hg]" />
</valueQuantity>
</component>
</Observation>
</resource>

</entry>

<entry>

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<category>
<coding>
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<code value="survey" />
<display value="Survey" />
</coding>
</category>
<code>
<coding>
<system value="http://snomed.info/sct" />
<code value="1104441000000107" />
<display value="ACVPU (Alert Confusion Voice Pain Unresponsive) scale score" />
</coding>
</code>
<subject>
<reference value="Patient/ad2c58ab-ffab-4366-9c76-b0322e22e881" />
</subject>
<effectiveDateTime value="2018-10-04T14:17:59+01:00" />
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<valueCodeableConcept>
<coding>
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<code value="248234008" />
<display value="Mentally alert" />
</coding>
</valueCodeableConcept>
</Observation>
</resource>

</entry>

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