Policy documents

Summary

The requester asked for Manx Care's current sepsis policy and the specific sepsis and NEWS policies in effect on January 11th and 12th, 2025. Manx Care confirmed that all requested information was provided, attaching the current policies which were also the ones adhered to on the specified dates.

Key Facts

• Manx Care responded to the request on September 8, 2025, stating all information was sent.
• The current Manx Care sepsis policy is the same one that was in effect on January 11th and 12th, 2025.
• The National Early Warning Score (NEWS) policy in effect on January 11th and 12th, 2025, is version 2.0.
• The NEWS2 policy was authored by the Critical Care Outreach team, Resuscitation committee, and Chief Nursing Information Officer.
• The NEWS2 policy is effective from October 2023 with the next review due in October 2026.

Data Disclosed

• 2025-09-08
• 2025-08-21
• January 11th & 12th 2025
• 29
• 3
• 4890489
• 2.0
• October 2023
• October 2026
• 2017

Original Request

I am requesting copies of the following Manx Care policies: 1. The current Manx Care sepsis policy. 2. The Manx Care sepsis policy that was adhered to on January 11th & 12th 2025 3. The National Early Warning Score (NEWS) policy that was adhered to on 11th & 12th January 2025.

Data Tables (8)

Full Response Text

Manx Care Noble’s Hospital, Strang Braddan, Isle of Man IM4 4R (01624) 650 000

Our ref: 4890489 8 September 2025

Dear

We write further to your request, received 21 August 2025, which states:

"I am requesting copies of the following Manx Care policies:
1. The current Manx Care sepsis policy.
2. The Manx Care sepsis policy that was adhered to on January 11th & 12th 2025
3. The National Early Warning Score (NEWS) policy that was adhered to on 11th & 12th January 2025."

Response

1. The current Manx Care sepsis policy.

A copy of this policy is attached.

1. The Manx Care sepsis policy that was adhered to on January 11th & 12th 2025

The attached policy is the one that was being adhered to on requested dates.

1. The National Early Warning Score (NEWS) policy that was adhered to on 11th & 12th January 2025."

A copy of this policy is attached and is the one adhered to on the requested dates.

Please quote the reference number 4890489 in any future communications.

Your right to request a review

If you are unhappy with this response to your freedom of information request, you may ask us to carry out an internal review of the response, by completing a complaint form and submitting it electronically or by delivery/post.

An electronic version of our complaint form can be found by going to our website at https://services.gov.im/freedom-of-information/Review . If you would like a paper version of our complaint form to be sent to you by post, please contact me and I will be happy to arrange for this. Your review request should explain why you are dissatisfied with this response, and should be made as soon as practicable. We will respond as soon as the review has been concluded.

If you are not satisfied with the result of the review, you then have the right to appeal to the Information Commissioner for a decision on; 1. Whether we have responded to your request for information in accordance with Part 2 of the Freedom of Information Act 2015; or 2. Whether we are justified in refusing to give you the information requested.
In response to an application for review, the Information Commissioner may, at any time, attempt to resolve a matter by negotiation, conciliation, mediation or another form of alternative dispute resolution and will have regard to any outcome of this in making any subsequent decision. More detailed information on your right to a review can be found on the Information Commissioner’s website at www.inforights.im. Should you have any queries concerning this letter, please do not hesitate to contact me. Further information about freedom of information requests can be found at www.gov.im/foi.

I will now close your request as of this date.

Yours sincerely

Page 1 of 18

POLICY FOR THE ADULT NATIONAL EARLY WARNING SCORE (NEWS2)

Author(s)
Critical Care Outreach team (CCOT), Resuscitation committee, Chief Nursing Information Officer (CNIO)
Version Number
2.0
Document effective from
October 2023
Next review due
October 2026

Intended audience
All Manx Care clinical staff
Superseded documents
NEWS2 v1
Stakeholders consulted prior to ratification
Resuscitation Committee
Ratified by
Patient safety and quality team
Date
Previous reviews
n/a
Changes made during latest review
n/a

1. Introduction

The purpose of this policy is to ensure that all clinical staff are aware of their responsibilities with respect of the accurate assessment of a patient’s clinical observations, calculation of their National Early Warning Score (NEWS) and escalation of care to appropriate clinicians. Manx Care follows the updated Royal College of Physicians (RCP) 2017 National Early Warning Score NEWS 2.

NEWS2 is now predominantly in electronic format for the completion of observations using Patientrack. As there are some occasions when using a paper chart may still be used, the recording of observations within this policy refers to both paper and electronic versions.

NEWS2 sets the minimum clinical monitoring and response that should occur to a physiological score and was developed as an aid to clinical assessment, not as a substitute for competent clinical judgment. Clinical concern about a patient’s condition must always override the NEWS2, with senior advice sought regarding the management of patients who demonstrate deterioration, regardless of their NEWS.

The Critical CARE Outreach team (CCOT) can also be contacted for Clinical advice/concern regardless of the NEWS.

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1. Purpose

Measurement of physiological observations is a well-established way to detect clinical deterioration in acutely ill patients. NEWS2 is an evidence-based tool designed to flag physiological deterioration at an early stage when it is easier to respond to and correct.
2.1
Manx Care patients who are at risk of acute deterioration may be identified by changes in their physiological parameters. Early recognition of deterioration and escalation to appropriate responders may therefore prevent serious adverse events.

NEWS2 will:

2.2
Minimise the risk of undetected physiological deterioration in patients.

2.3
Focus nursing and medical resources on patients most at risk of deterioration.
2.4
Facilitate appropriate communication regarding patient deterioration to key
personnel.

2.5
Enable appropriate personnel to respond to deterioration in a timely manner.
2.6
Ensure patients are cared for in an environment appropriate to their clinical condition.
2.7
Support early clinical decisions regarding a patient’s resuscitation and escalation of care status.
2.8
Assist to prevent escalation or intervention when it is not in the patient’s best interests.

2.9
Enable a record to be kept to review a patient’s condition.

1. Scope and exclusions

3.1
This policy relates to all adult inpatient admissions/ED attendances (≥16yrs) within the acute hospital setting with the following exclusions:
3.2.0
Paediatric patients, who may be 16 years of age but where the current paediatric observation and escalation protocol (PEWS) has been deemed by a senior clinician as more appropriate.
3.2.1
Maternity patients, where the current maternal observation and escalation protocol must be followed.

3.2.2
Patients on ICU.

3.2.3
Patients on HDU – at the discretion of responsible consultant.

3.2.4
Patients in the operating theatre or recovery area.

3.2.5
Patients undergoing endoscopy.

3.2.6
Patients undergoing interventional procedures in radiology.

3.2.7
Patients undergoing procedures as outpatients.

Page 3 of 18

3.2.8
Patients who are in the Emergency Department due to a minor injury – at the discretion of the Nurse in Charge the ‘minor injuries’ flag can be applied on to Patientrack which will cease scheduling of observations
3.2.9
Policies and procedures specific to the areas detailed in 3.1 should apply. Prior to discharge to a general ward area, at least two sets of observations should be
recorded on Patientrack or on the NEWS2 chart. This must be communicated on handover to the ward staff taking over care of the patient.
3.3
If a patient is scoring medium or high prior to discharge or following a procedure, they will require a formal medical review (above foundation grade) before transferring to a ward area.
3.4
The following patients will require additional observation profiles as per specific policy or guideline:

3.4.1
Post-operative patients.

3.4.2
Post-endoscopy patients.

3.4.3
CCU patients (as per organisational care pathways).

3.4.4
Patients receiving patient controlled analgesia.

3.4.5
Patients receiving continuous epidural infusions.
3.4.6
Patients post-interventional radiology procedure (as per organisational care pathways).

3.4.7
Patients undergoing neurological observations for head injury

3.4.8
Patients undergoing transfusion of blood products.

3.4.9
Patients undergoing stroke care (as per organisational care pathways).
3.5
Patients undergoing routine investigations off the ward area (x-ray/echo etc) may have observations temporarily suspended whilst they are off the ward.
3.6
Patients undergoing End of Life care (EOL) may have all or some of their observations discontinued. This decision can only be taken following discussion with the consultant from the responsible team (out of hours must be on-call consultant). This option can be applied on Patientrack with an EOL flag with the decision documented in the patient’s notes. It should be discussed with the patient and/or family (with patient’s consent).

1. Roles and Responsibilities

• This policy will be subject to review, consultation and approval from the Patient Safety and Quality Committee.
• The Resus Committee will advise on issues relating to NEWS2 and have overall responsibility for overseeing monitoring and compliance of the NEWS2 policy.
• Data collection & audit will be taken monthly to monitor compliance
• Senior Management Team will be consulted if there are concerns about adherence to the policy
• Senior management team will also support the Resuscitation Committee to ensure the policy is fully embedded to reduce the risk of patient deterioration throughout the organisation.
• The patient safety and quality team, along with the Medical Director and associated

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Clinical Directors for medicine, Surgery, Women & Children’s, Emergency Care, Anaesthetics and Theatres, Head of Nursing and Associate Directors of Nursing are responsible for:
• Ensuring the organisation has robust policies and appropriate resources relating to the monitoring of clinical observations and the prevention of patient deterioration and will ensure all clinical areas in their divisions implement and comply with the policy.
• Are responsible for all clinical staff within their division attending NEWS2 mandatory training.
• Are responsible for implementing this policy within their clinical areas and ensuring staff understand their accountability and responsibility in relation to complying with this policy.
• Will ensure wards/departments have an up to date NEWS2 escalation pathway visible at all nursing stations.
• Individual Clinical Staff, ward/department employees who measure, record and respond to patient observations are responsible for:
• Attending their mandatory NEWS2 training.
• Practicing in accordance with the clinical guidance set out within this policy.
• Entering ‘real time’ data onto the Electronic Patient Record (EPR) system.
• Fully comply with their code of conduct in relation to documentation and record keeping.

1. Definitions

5.1
NEWS2 is based on the allocation of points (0 to 3) for six physiological parameters:

5.1.1 Respiratory rate.

5.1.2 Oxygen saturations.

5.1.3 Temperature.

5.1.4 Systolic blood pressure.

5.1.5 Heart rate.

5.1.6 Level of consciousness including new onset of confusion.
5.2
Points are allocated to each parameter based on the deviation from normal values, with an aggregate score calculated.

5.3
A score must be calculated for every set of observations taken.

5.4
The score is increased by 2 points for the use of supplementary oxygen.
5.5
The NEWS2 must be recorded on Patientrack or where not available on a chart (appendix 1).
5.6
The escalation pathway (appendix 2) specifies the actions required by healthcare professionals.

5.7
There are three trigger levels:

5.7.1 Low an aggregate score of 1-4.
5.7.2
A single red score an extreme variation in an individual physiological parameter (a score of 3 in any one parameter, which is colour coded red on NEWS2).

5.7.3 Medium an aggregate score of 5-6.

5.7.4 High an aggregate score of 7 or more.

Page 5 of 18

5.8
The escalation pathway determines the frequency of observations and stipulates when escalation to other responders occurs. Once automated alerting is implemented, some elements will take place in an automated manner.
5.9
The escalation pathway also identifies when transfer of the patient to a higher level of care (HDU/ICU) should be considered.

Decisions to admit to HDU/ICU must involve the consultant from the team responsible (out of hours must be the on-call consultant) and the consultant anaesthetist.

1. Recording

6.1
All adult patients admitted to hospital or attending ED must have their physiological parameters recorded using NEWS2 (see para 3.1 for exclusions).
6.2
Patients seen in pre-admission clinic must have a baseline set of observations recorded using NEWS2 in preparation for their elective admission.
6.3
Patients must have a full set of observations recorded when first admitted or transferred to a ward area.
6.4
All emergency admissions to Noble’s Hospital must have observations carried out 6hrly as a minimum for the first 48hrs of admission. If the patient’s NEWS2 remains at 0 for 48hrs, observation frequency can transfer to 12hrly. For admissions and transfers to Ramsey Hospital please refer to Appendix 3.

6.5
When using a paper chart all sections of the chart must be completed.
6.6
Additional observations such as neurological observations must be completed on a supplementary chart or on Patientrack.
6.7
The undertaking and recording of the patient’s vital signs is the responsibility of the registered healthcare professional.
6.8
Healthcare Assistants (HCA’s) may undertake routine observations except in the following circumstances:

6.8.1
First set of observations in a new clinical area.

6.8.2
First set of observations after an invasive procedure.

6.8.3
Patients in receipt of a blood product transfusion.

6.8.4
Patients with opiate analgesic infusions or PCA.

6.8.5
Patients with continuous epidural infusions.

6.8.6
Patients who’s last NEWS2 is at a medium or high level (≥5).

6.8.7
Patients undergoing neurological observations for head injury.

6.9
Unrecordable/unrecorded observations are given a score of 3.
6.10
New confusion or agitation may indicate acute physiological deterioration and must prompt a medical review.
6.11
If a patient refuses to have observations taken, the nurse in charge and medical team must be informed and a capacity assessment completed. The assessment must be documented in the medical and nursing notes.

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1. Escalation and Response

7.1.1
Once an aggregate NEWS2 has been calculated and recorded the

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