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Implementation of the National Early Warning Score in UK care homes: a qualitative evaluation

Lookup NU author(s): Dr Siân Russell, Dr Rachel Stocker, Dr Robert Barker, Dr Jenny Liddle, Professor Joy Adamson, Professor Barbara Hanratty



This is the authors' accepted manuscript of an article that has been published in its final definitive form by Royal College of General Practitioners , 2020.

For re-use rights please refer to the publisher's terms and conditions.


Background: The National Early Warning Score (NEWS) is a tool for identifying and responding to acute illness. It has been introduced into care homes in northern England, aiming to enhance identification of, and communication about, acute illness. Care home staff measure residents’ vital signs, and record them on a tablet computer which calculates a NEWS, to share with health services. This paper outlines an evaluation of NEWS implementation in care homes across one Clinical Commissioning Group (CCG) area. Aim: To identify challenges to implementation of NEWS in care homes. Design and Setting: Qualitative interviews were conducted with fifteen staff from six care homes, five health professionals and one CCG employee, to capture attitudes and experiences of the intervention. Following an inductive thematic analysis, data were considered deductively against Normalisation Process Theory constructs, to identify implementation challenges and successes. Results: Care home staff and other stakeholders acknowledged that NEWS could enhance the response to acute illness, improve communication with the NHS and increase confidence of care home staff. However the implementation did not account for the complexity of either the intervention or the care home setting. Challenges to engagement included competing priorities, insufficient training, and shortcomings in communication. Conclusion: This evaluation highlights the need to involve care home staff and the primary care services that support them in the development and implementation of interventions in care homes. The appropriateness and value of NEWS within non-acute settings requires ongoing monitoring.

Publication metadata

Author(s): Russell S, Stocker R, Barker R, Liddle J, Adamson J, Hanratty B

Publication type: Article

Publication status: Published

Journal: British Journal of General Practice

Year: 2020

Volume: 70

Issue: 700

Pages: e793-e800

Online publication date: 06/10/2020

Acceptance date: 01/04/2020

Date deposited: 12/06/2020

ISSN (print): 1478-5242

ISSN (electronic): 1478-5242

Publisher: Royal College of General Practitioners


DOI: 10.3399/bjgp20X713069


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