Developing the hypoglycemia-nursing early warning score system (Hy-NEWSS): A pilot study

  • Ahmad Hasyim Wibisono
    School of Nursing, Faculty of Medicine, Universitas Brawijaya, Indonesia.
  • Dennti Kurniasih
    Nursing Department, RSUD Abdul Moeloek, Lampung, Indonesia.
  • Eti Sumartiyah
    Nursing Department, RSUPN Dr Cipto Mangunkusumo, Jakarta, Indonesia.
  • Rima Novia Putri
    Nursing Department, State Health Polytechnic, Tanjung Pinang, Indonesia.
  • Dikha Ayu Kurnia
    Faculty of Nursing, University of Indonesia, Depok, Indonesia.
  • Yunisar Gultom
    Nursing Department, RSUPN Dr Cipto Mangunkusumo, Jakarta, Indonesia.
  • Debie Dahlia
    Faculty of Nursing, University of Indonesia, Depok, Indonesia.


Background: Severe hypoglycemia occurs in 6% of type 2 DM patients with a 6 to 7% mortality rate. Amidst the COVID-19 pandemic, there has been a higher rate of fatality among diabetes patients, at least 22% of COVID-19 deaths in Wuhan, China. Furthermore, the condition impairs physiological defense against recurrent hypoglycemia in the future. Accordingly, the innovation in this study aims to prevent severe hypoglycemia among type 2 patients through early risk screening, the use of preventative protocols, and patient and family empowerment. This intervention bundle is called Hypoglycemia-Nursing Early Warning Score System (Hy-NEWSS).

Design and Methods:
 The innovation was implemented in inpatient and outpatient settings, within two weeks with the following sequence:
i) internal training,
ii) Hy-NEWSS implementation,
iii) outcomes evaluation.

 Of the twenty-eight patients involved in the study, 3 patients (19%) had a high risk of hypoglycemia, while the remaining had a low risk for the condition. However, at the end of the study there was no event of severe hypoglycemia (0%), and only 1 event (6.33%) of mild hypoglycemia. The results also showed that the accuracy of nurses in implementing the protocols was 93% and that during the evaluation, 95.62% of the responses of the nurses from the inpatient and outpatient settings were positive. Finally, the scores of the sensitivity and specificity evaluation were 99% and 88%, respectively.

 It may be concluded from this initial study that Hy-NEWSS is effective in preventing severe hypoglycemia, accurate in identifying patient risk level for the condition, and has high applicability to be implemented in hospital settings.


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