Addendum
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Addendum
Root® with EWS
Addendum, Root Operator's Manual: Early Warning Score (EWS) This addendum provides updates to the following: Operator's Manual, Root
®
•
37365/LAB-8425 and equivalent translations
•
37503/LAB-8542 and equivalent translations ®
Operator's Manual, Root with noninvasive blood pressure and temperature •
37705/LAB-8747 and equivalent translations
•
38280/LAB-9274 and equivalent translations
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Safety Information, Warnings, and Cautions Performance Warnings and Cautions WARNING: The Early Warning Score (EWS) feature is intended to help clinicians calculate Early Warning Scores based upon established methods. WARNING: The Early Warning Score (EWS) feature is not intended as a definitive assessment of the patient condition. The result should be evaluated in conjunction with the patient’s clinical status and confirmed with additional diagnostic tests consistent with each hospital’s policy. WARNING: Confirm the Early Warning Score (EWS) being used is suitable for the patient type and conditions. Certain EWS systems may exclude certain patient types and patient conditions. Note: The Early Warning Score (EWS) is a static calculation based upon the captured and manually inputted parameter data at the time of the calculation request.
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Operation EWS is an optional feature of Root that can be enabled through the Access Control settings. Refer to the Operator's Manual for Root or Root with noninvasive blood pressure and temperature.
Access Control Option
Description
Factory Default Setting
Configurable Settings
EWS Enabled
Enables / disables the EWS feature. See Early Warning Score (EWS) on page 6.
Off
On or Off
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Addendum, Root with EWS
Operation
Early Warning Score (EWS) Root has the ability to automate Early Warning Score (EWS) calculations based upon published standards such as National Early Warning Score (NEWS), Pediatric Early Warning Score (PEWS), Children's Early Warning Tool (CEWT), or can be customized to match a facility's protocol. As a default, EWS on Root is aligned with the NEWS system established by the Royal College of Physicians* using seven (7) physiological contributors as the basis of the scoring system. Based on NEWS, each physiological contributor is scored from 0 to 3 according to the mapping from its range to a score (for example, pulse rate from 51 to 90 equates to a 0 score). All of the scores are aggregated to provide the NEWS. The EWS is an optional feature of Root that can be enabled through the Access Control setting. See Access Control on page 5. The EWS feature works by automating established EWS calculations based upon all of the following contributors: •
Oxygen Saturation (SpO2)
•
Pulse Rate (PR)
•
Respiration Rate (RR)
•
Body Temperature (TEMP)
•
Systolic Blood Pressure (SYS)
•
Level of Consciousness (LOC)
•
Supplemental O2 (Sup. O2)
Root can also be configured** to include the following additional contributors: •
Respiratory Distress (RD)
•
Capillary Refill Time (CRT)
The EWS calculation can be performed one of two (2) ways: •
Stand-Alone EWS Calculation: When NOT connected to Patient SafetyNet*** and an EMR system, through the EWS Action Menu. See Stand-Alone EWS Calculation on page 7.
•
EWS Calculation Using EMR Push: When connected to Patient SafetyNet and an EMR system, through EMR Push operation. See EWS Calculation Using EMR Push on page 10.
For information on how EWS is calculated, see How the EWS is Calculated on page 11. * Royal College of Physicians. National Early Warning Score (NEWS): Standardising the assessment of acute illness severity in the NHS. Report of a working party. London: RCP, 2012. **Configured by authorized personnel only. ***The use of the trademark PATIENT SAFETYNET is under license from University Health System Consortium.
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Addendum, Root with EWS
Operation
Stand-Alone EWS Calculation Stand-Alone EWS calculation is performed through the EWS window Action Menu.
1.
To perform a Stand-Alone EWS Calculation, select the Menu. The Root EWS Screen will then be displayed.
2.
Manually input EWS contributors not automatically captured. See EWS Manually Entered Contributor Settings on page 8 for information about settings. Note: Automatically captured data cannot be manually adjusted. Manual-entry contributors will be provided with a drop-down or slider to allow data entry.
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icon from the Action
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Addendum, Root with EWS 3.
Operation
Select OK to display the EWS. The individual contributor scores (1) and EWS aggregate score (2) will appear in the EWS window of the Main Screen along with the time and date (3) the score was provided. Additionally, the time since the last EWS Calculation (4) was performed will appear directly below the EWS aggregate score.
Reset EWS To reset EWS contributors, select the icon from the EWS Action Menu on the Main Screen. This will reset all EWS contributors until a new EWS calculation is performed.
EWS Manually Entered Contributor Settings Options
Description
Factory Default Settings
User Configurable Settings
RR*
Respiration Rate
--
-- and 1 to 70 in increments of 1 -- and from 80.1°F to 110.0°F in increments of 0.1
Temperature**
Patient temperature measurement
--
Systolic**
Patient systolic measurement
--
-- and 41 to 260 in increments of 1
--
--, A (Alert), V (Responds to Voice), P (Responds to Pain), or U (Unresponsive)
Level of Consciousness
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Patient level of Consciousness
8
-- and from 26.8°C to 43.3°C in increments of 0.1
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Addendum, Root with EWS
Options
Operation
Description
Factory Default Settings
Supplemental oxygen
--
User Configurable Settings Supplemental Oxygen settings: --, On, or Off
Sup. O2
Flow Rate settings: Flow rate provided to patient
--
--, Off, 1/4 L/min to 15 L/min in increments of 1/4 L/min.
Respiratory Distress (RD)
Assessment of the severity of difficulty breathing
--
--, Nil, Mild, Moderate, and Severe
Capillary Refill Time (CRT)
Time taken for color to return to an external capillary bed after -the application of pressure to the point of blanching
--, 1 to 4 sec in increments of 1 sec
* Displays when device or sensor is not connected to Root. ** Not displayed if a temperature/blood pressure measurement is taken using Root with noninvasive blood pressure and temperature.
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Addendum, Root with EWS
Operation
EWS Calculation Using EMR Push EWS Calculation Using EMR Push is performed through the EMR Push icon when the Root is connected to Patient SafetyNet and an EMR system. For more information about EMR push, see Sending Data to the EMR in the Operator's ® Manual, Root® with noninvasive blood pressure and temperature or in the Operator's Manual, Root . 1.
To perform an EWS Calculation Using EMR Push, select the EMR Push icon from the Action Bar. The Root EMR Push Screen will then be displayed with automatically captured contributor settings.
2.
Manually input EWS contributors not automatically captured. See EWS Manually Entered Contributor Settings on page 8 for information about settings.
Note: Automatically captured data cannot be manually adjusted. Manual-entry contributors will be provided with a drop-down or slider to allow data entry. ® See EMR Push Manual-Entry Item Settings in the Operator's Manual, Root with® noninvasive blood pressure and temperature or in the Operator's Manual, Root . for information about settings.
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Addendum, Root with EWS
Operation
The EWS individual contributor scores (1) and EWS aggregate score (2) will be displayed at the top of the EMR Push screen.
The individual contributor scores (1) and EWS aggregate score (2) will also appear in the EWS window of the Main Screen along with the time and date (3) the score was provided. Additionally, the time since the last EWS Calculation (4) was performed will appear directly below the EWS aggregate score.
How the EWS is Calculated Individual EWS contributors are scored in accordance with the guidance provided from NEWS. Note: These scores are a reflection of NEWS standards; they may not be reflective of NEWS if Root is customized. Score/Physiological Parameters
3*
2
Oxygen Saturation (SpO2)
≤91
92-93
94-95
≥96
--
Pulse Rate (PR)
≤40
--
41-50
51-90
91-110
Respiration Rate (RR)
≤8
--
9-11
12-20
--
Body Temperature (TEMP) °C
≤35.0
--
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1
0
1
2
35.1-36.0 36.1-38.0 38.1-39.0 11
3* --
--
111-130 ≥131
21-24
≥25
≥39.1
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Addendum, Root with EWS
Operation
Score/Physiological Parameters
3*
Body Temperature (TEMP) °F
≤95.0
--
95.1 96.8
96.9 100.4
100.5 102.2
≥102.3
--
Systolic Blood Pressure (SYS)
≤90
91-100
101-110
111-219
--
--
≥220
Level of Consciousness (LOC)
--
--
--
A
--
--
V, P, or U
Supplemental O2 (Sup. O2)
--
Yes
--
No
--
--
--
2
1
0
1
2
3*
* A score of 3 is representative of an extreme variation in a single physiological parameter.
EWS Clinical Risk Level Indicators WARNING: The Early Warning Score (EWS) feature is intended to help clinicians calculate Early Warning Scores based upon established methods. WARNING: The Early Warning Score (EWS) feature is not intended as a definitive assessment of the patient condition. The result should be evaluated in conjunction with the patient’s clinical status and confirmed with additional diagnostic tests consistent with each hospital’s policy. Clinical risk levels are defaulted to those established by the Royal College of Physicians for NEWS. The aggregate EWS score on Root provides the following color indicators for different clinical risk levels: EWS Score
NEWS Clinical Risk Aggregated Score Color
0 or an aggregate EWS of 1 to 4
Low
Green
Individual parameter score of 3 or Medium
Yellow
Aggregate EWS score of 5 to 6 Aggregate EWS of 7 or higher
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High
Red
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Addendum, Root with EWS
Operation
E Indicator The E Indicator appears when a contributor exceeds a user defined threshold. Thresholds are customized using the Masimo Instrument Configuration Tool (MICT) by authorized personnel. When the contributor threshold is exceeded, the overall EWS score is replaced with an "E" in a red box (see screen shot below). Each contributor can be configured to have an E Indicator.
EWS Prompt Window The EWS prompt window displays customized messages based on a calculated score to prompt clinician for next steps. Messages can be customized according to hospital protocol using MICT by authorized personnel.
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Troubleshooting Troubleshooting EWS Symptom
EWS Action Menu does not display on Root
Selecting EMR push icon does not perform EWS calculation
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Possible Cause
Correction
Root has become disconnected from Patient SafetyNet.
Power cycle Root to display the EWS Action Menu.
EWS not enabled on Root.
Confirm EWS feature is enabled in the Access Control Menu.
EWS not enabled on Root.
Confirm EWS feature is enabled in the Access Control Menu.
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Addendum, Root with EWS
Troubleshooting
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