Early Warning Score System

Sistem Skoring Peringatan Dini

Pradith T. Wijonarko
dr.pradithteguh@gmail.com
Lecturer Vitae
https://www.linkedin.com/in/pradith-teguh-wijonarko-b2a78433/
 PENDAHULUAN

Pasien harus dipantau supaya kita dapat

mengenali :
Yang kondisinya menurun, atau
Yang berisiko mengalami penurunan kondisi

Royal college of physicians. National early warning score (NEWS) : standardising the assessment of acute-illness severity in the NHS. London. 2012.p1-
3
Early Warning Systems
Beragam Acuan yang dipakai
 Sistem Skoring Peringatan Dini

• Bertujuan meningkatkan :
- Pengawasan keadaan perburukan yang
cepat
- Deteksi perburukan klinis
- Inisiasi tanggapan klinis yang cepat dan
tepat

Mc Neilla, G, Bryden, D. Do either early warning systems or emergency response teams improve hospital patient survival? A systematic review.
Resuscitation 84 (2013) 1652–1667
 Ukur dan catat skor dari 6 tanda fisiologis pasien

Jumlahkan skor, tambahkan 2 jika pasien

menggunakan oksigen tambahan

Pilih tindakan sesuai skor dan catat:

•Peningkatan perawatan klinis yang dibutuhkan dan alasannya

•Kompetensi kajian klinis yang dibutuhkan

•Frekuensi pemantauan yang butuhkan

•Keadaan ruang rawat yang dibutuhkan

Parameter Fisiologis

Royal college of physicians. National

early warning score (NEWS) :
standardising the assessment of
acute-illness severity in the NHS.
London. 2012.p1-3
 Respiration Rate

• Elevated respiratory rate is a powerful sign of

acute illness and distress, in all patients.
• Reduced respiratory rate is an important
indicator of CNS depression and narcosis.

Royal college of physicians. National early warning score (NEWS) : standardising the assessment of acute-illness severity in the NHS. London. 2012.p11
 Oxygen Saturation

• Oxygen saturations are a powerful tool for the

integrated assessment of pulmonary and
cardiac function
• The technology required for the measurement
of oxygen saturations, ie pulse oximetry, is
now widely available, portable and
inexpensive.

Royal college of physicians. National early warning score (NEWS) : standardising the assessment of acute-illness severity in the NHS. London. 2012.p11
 Temperature

• Temperature are sensitive markers of acute-

illness severity and physiological disturbance.

Royal college of physicians. National early warning score (NEWS) : standardising the assessment of acute-illness severity in the NHS. London. 2012.p1-3
 Systolic BP

• Falling systolic blood pressure (hypotension)

that is most significant in the context of
assessing acute-illness severity.
• Hypertension is given less weighting in the
context of acute-illness assessment
• Diastolic blood pressure does not form part of
the scoring system for acute-illness severity
Royal college of physicians. National early warning score (NEWS) : standardising the assessment of acute-illness severity in the NHS. London. 2012.p13
 Pulse Rate

• Tachycardia
– circulatory compromise due to sepsis or volume
depletion, cardiac failure, pyrexia, or pain and
general distress, cardiac arrhythmia, metabolic
disturbance, eg hyperthyroidism, or drug
intoxication, eg sympathomimetics or
anticholinergic drugs.
• Bradycardia
– consequence of medication, eg with beta-
blockers, hypothermia, CNS depression,
hypothyroidism or heart block.
Royal college of physicians. National early warning score (NEWS) : standardising the assessment of acute-illness severity in the NHS. London. 2012.p13
 Level of consciousness

• New onset or worsening confusion should

always prompt concern about potentially
serious underlying causes and warrants urgent
clinical evaluation.

Royal college of physicians. National early warning score (NEWS) : standardising the assessment of acute-illness severity in the NHS. London. 2012.p13
 • Moon et al MEWS Charts were
associated with significant reductions in
– the incidence of cardiac arrest calls,
– the proportion of patients admitted to
intensive care having undergone in-hospital
CPR and
– their in-hospital mortality

Moon, et al. An eight year audit before and after the introduction of modified early warning score (MEWS) charts, of patients admitted to a tertiary
referral intensive care unit after. Resuscitation 82 (2011)p150–4
Royal college of physicians. National early warning score (NEWS) : standardising the assessment of acute-illness severity in the NHS. London. 2012.p1-3

A weighting score of 2 should be added for any patient requiring

supplemental oxygen (oxygen delivery by mask or nasal cannulae)
 Scale of Clinical Risk

Royal college of physicians. National early warning score (NEWS) : standardising the assessment of acute-illness severity in the NHS. London. 2012.p3
 PIMPINAN
PERAWAT

Royal college of physicians. National early warning score (NEWS) : standardising the assessment of acute-illness severity in the NHS. London. 2012.p11
 TIM DOKTER
PENANGGUNG
JAWAB PASIEN

TIM REAKSI CEPAT

Royal college of physicians. National early warning score (NEWS) : standardising the assessment of acute-illness severity in the NHS. London. 2012.p13
 Rekam Medik Skor Peringatan Dini

Royal college of physicians. National early warning score (NEWS) :

Standardising the assessment of acute-illness severity in the NHS. London.
2012.p14
 Rekam Medik Skor Peringatan Dini

Royal college of physicians. National early warning score (NEWS) :

Standardising the assessment of acute-illness severity in the NHS. London.
2012.p14
 Rekam Medik Skor Peringatan Dini

Royal college of physicians. National early warning score (NEWS) :

Standardising the assessment of acute-illness severity in the NHS. London.
2012.p14
 Modifikasi EWS

►Untuk sementara bila Oxymeter belum tersedia,

pemantauan memakai Capillary Refill Time (CRT)
Bila CRT 1-2' : skor 1
CRT 2-3” : skor 2
CRT >3” atau CRT berapapun dengan akral dingin :
skor 3

►Oksigen Suplementasi tidak dinilai (karena

kendala teknis) maka digantikan penilaian dengan
sianosis atau retraksi dengan skor (Ringan skor 2
sd berat skor 3)
Note : Apabila saturasi turun dan pasien mdapatkan
suplementasi oksigen tetap mendapat skor 2
 Modifikasi EWS

►Untuk nilai Tekanan Darah terdapat koreksi :

T Systole ≥180 : skor 2 ; T Systole ≥ 220 : skor 3
T Diastole ≥ 110 : skor 3

►Untuk nilai Respirasi terdapat koreksi :

Rr 21 – 30 : skor 2
Rr ≥ 35 : skor 3

►Clinical Approvement dan Laboratory Finding

mendapat skor 3
 Modifikasi EWS

►GDS tetap disarankan wajib screening (via kapiler

atau vena tgantung penilaian klinis)

►Prasyarat nilai untuk memasuki ruang intensif bila

Skor Total ≥ 8 untuk HCU/R. Observasi
Skor Total ≥ 10 untuk ICU/ICvCU/PICU/NICU

Modified by dr Iranima SpAn KIC

TMRC RSCM
 Modified
early
obstetrics
warning
system

Seftona, G et al. What impact did a Paediatric Early Warning system have on emergency admissions to the paediatric intensive care unit? An observational cohort
Singh, S, et al. A validation study of CEMACH recommended modified early obstetrics
study. Intensive and Critical Care Nursing (2014)
Singh, S, et al. A validation study of CEMACH recommended modified early obstetrics warning system. Anaesthesia 67.2012.p12-8
warning system. Anaesthesia 67.2012.p12-
 MEOWS

British Journal of Midwifery. December 2, 2014.

 MEOWS

British Journal of Midwifery. December 2, 2014.

 Pediatric
• early warning
tools

Seftona, G et al. What impact did a Paediatric Early Warning system have on emergency admissions to the paediatric intensive care unit? An observational
cohort study. Intensive and Critical Care Nursing (2014)
Singh, S, et al. A validation study of CEMACH recommended modified early obstetrics warning system. Anaesthesia 67.2012.p12-8
(J Community Hosp Intern Med Perspect. 2015; 5(2): 10.3402/jchimp.v5.26716.)
DISKUSI