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NEWS2 National Early Warning Score
Introduction for assessment, recording and documentation Adrian Debney RGN BA(Hons) PG MH Ed, NMC TCH, CTTLS Nicola A Cook RGN, MRes, Nurse Consultant Adrian Debney
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Learning Outcomes Describe the benefits of NEWS2
List three main ways in which NEWS2 is to be used Describe the Seven Physiological Parameters included in NEWS2 Describe the NEWS2 assessment process, threshold and triggers Demonstrate correct use of NEWS2 and its clinical response
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1. What is a National Early Warning Score (NEWS2)?
NEWS2 is a track-and-trigger early warning score system used to identify and respond to patients at risk of deteriorating. A simple scoring system is allocated to physiological measurements when patients are being monitored in health care settings. . NEWS [1] (National Early Warning Score) is probably the best validated track-and-trigger early warning score system (EWS) and is used in the majority of UK hospitals to identify and respond to patients at risk of deteriorating or sepsis A recent Patient Safety Measurement Unit survey demonstrated that 64.6% of the 127 acute trusts who responded, used an unmodified NEWS; 14.2% used a modified NEWS and 19.7% used another early warning score. [5] Potential harm could occur as a result of having variable scoring systems across regions, or even within the same organisation, and this is magnified when we consider how frequently staff and patients move aroun
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Introducing…News2 QEH documentation
In December 2017, an updated version of NEWS (NEWS 2) was published. It contains welcomed improvements on the previous version of NEWS [6]. For example, the chronic hypoxia sub chart helps to better tailor escalation to baseline oxygen levels in those with respiratory disease. It also includes the addition of delirium to the consciousness sub chart, and the reinforcement of the value of aggregate scores versus single parameter extreme recordings. Because NEWS was developed from comparing the observations of emergency admission survivors and non survivors, and infection is the most common reason for admission, it is unsurprising that NEWS is at the heart of the national operational definition for sepsis.
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NEWS 2: Key Differences 2 Urine Output Oxygen O2 Saturations AVPU
Not included in NEWS2 but still very important! 2 hourly Fluid Balance for NEWS ≥ 5 Any abnormality will now score 3, including new confusion Any patient on O2 will now score 2 SpO2 now included Choose scale according to your patient’s target SpO2: 94-98% (majority); 88-92% (e.g.COPD). For annual Elearning go to the website on
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Systolic blood pressure Pulse rate Level of consciousness
seven simple physiological parameters are included in the scoring system: Respiratory rate Oxygen Saturations Temperature Systolic blood pressure Pulse rate Level of consciousness A score is allocated to each physiological parameter. This score is then aggregated, and uplifted for people requiring oxygen.
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NEWS2 scoring responses…
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NEWS 2: Key Differences NEWS = 1 - 4 NEWS = 3 in one single parameter
1 hourly Obs Call Doctor Consider CCOT Start Fluid Chart Think Sepsis! 4 hourly Obs 1 hourly Obs Inform Doctor Consider escalation Consider Fluid Chart Urgent review by Registrar Referral to CCOT Clear management plan required Consider 2222 call ± ICU referral
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Introducing News2 QEH documentation
Back Page Note: Visual Analogue Scale (VAS) for pain Oxygen administration reference guidance Urine measurements warning triggers ‘Think Bufalo’ Sepsis screening tool assessment and response 1 2 3 4 3 4
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Accurate Fluid Balance is Crucial!
Urine: weight Pads Bedpans Bottles Catheter bags Stool: weight Flexiseal Vomit: weight Sick bowls Drains: Surgical Chest Ascitic NG: Aspirate Free Drainage N/saline 1000 AB1234 100 100 200 300 1300 Via infusion pump 100ml/h N/saline 1000 AB1234 Free drainage 1000mls/4h 1000 All drinks thickened or normal fluids PEG/ NG feed + flushes Fluids IV/SC Drugs: IVAB, insulin infusions, IV paracetamol, omeprazole, pabrinex…
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Ensure that label is affixed Document ward! Sign and Date every shift!
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Collated Score = 11 For example…. 1 2 3 4 5 The collated score then 6
Parameter Value Score Respiratory Rate 28 3 SpO2 (1) 89 Supplemental O2 Air Systolic BP 105 1 Heart Rate 101 Conscious Level Confusion Temperature 37.2 1 Step 1 Step 2 Step 3 2 3 4 5 The collated score then determines a response… 6 7 Collated Score = 11
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Total - 0 Total – 1- 4 3 in a single parameter Total:0
Minimum 12 hourly Continue routine NEWS monitoring Total 1 - 4 Minimum 4 – 6 hourly Inform registered nurse who must assess the patient Registered nurse decides whether increased frequency of monitoring or escalation of care is required. Total 3 in a single parameter Minimum 1 hourly Registered nurse to inform medical team caring for patient who will review and decide if escalation of care is necessary Consider Critical Care Outreach referral
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Minimum of half hourly obs and URGENT REVIEW
Total – 5 or more Total – 7 or more Total 5 or more Minimum 1 hourly Registered nurse to immediately inform the medical team caring for the patient Consider Critical Care Outreach referral Consider providing clinical care in an environment with monitoring facilities Total 7 or more Minimum of half hourly obs and URGENT REVIEW Registered nurse to immediately inform the medical team caring for the patient – should be at least specialist registrar level. Critical Care Outreach referral Consider emergency anaesthetic or 2222 call Consider transfer of care to a high dependency unit or Critical Care Unit Clinical care in an environment with monitoring facilities. Regarding continual monitoring please review via Medical Registrar/Outreach
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Case Scenario #1 Learning check: 64 year old female
Using the NEWS2 scorecard correctly assign a score from those listed below. Using SBAR, how would you escalate this? Respiratory rate = 18 Oxygen (1) saturations = 93 Supplemental oxygen = O2 2 lpm Systolic blood pressure = 95 / 54 Heart Rate = 112 Conscious level = responsive to voice Temperature = 37.8 Case Scenario #1 64 year old female Admitted with acute large bowel obstruction Dehydrated Reduced nutritional intake for 5 days 11 4 11 9 7
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Infective needle site (groin)
Learning check: Using the NEWS2 scorecard correctly assign a score from those listed below. Explain the response required. Respiratory rate = 22 Oxygen saturations = 91 Supplemental oxygen = air Systolic blood pressure = 105 / 59 Heart Rate = 111 Conscious level = new confusion Temperature = 38.9 Case Scenario #2 33 year old male Admitted with delirium – falls, found wandering, minor head injury with lacerations to face Know drug user Infective needle site (groin) Score = 12 8 12 3 9
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Know COPD with exacerbation and possible chest infection
Respiratory rate = 32 Oxygen saturations = 84 Supplemental oxygen = 2 litres via nasal cannulae Systolic blood pressure = 105 / 59 Heart Rate = 109 Conscious level = newly confused Temperature = 39.2 Learning check: Using the NEWS2 scorecard correctly assign a score from those listed below. Explain the response required. Case Scenario #3 A 68 year old lady Previous heavy smoker Know COPD with exacerbation and possible chest infection Score = 11 8 11 3 9
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Learning check: Read the NEWS 2 responses below.
Correctly identify the score which triggers each of these.
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Key learning message: “To provide the best care for your deteriorating patients it is important that clinicians by the bedside need to be informed of any changes in the NEWS2 scoring. By ensuring that we are professionally responsible and take the time to learn about NEWS2 and any ongoing updates by accessing the online website on a regular basis” Nicola A Cook, Nurse Consultant, Critical Care You can access the online training resource for NEWS2 at the following link:
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