• National early warning scoring (NEWS) is a track and trigger protocol that monitors vital observations to detect subtle changes in patient physiology
• score will trigger responses in accordance with escalation strategy
• NEWS is an aid to clinical decision making
• not a replacement for professional judgement
• senior clinical advice can be requested without reaching a NEWS trigger

• When taking patient observations, record on NEWS chart/Careflow Vitals

NEWS scoring items

• Respiration counted over 1 full minute
• Oxygen: must be prescribed
  • SpO₂ scales:
    • scale 1 – patients without hypercapnia
    • scale 2 – Patients with hypercapnia (validated by a clinician and documented in patient’s notes)
  • during each set of observations registered nurse validates rate and method of delivery of oxygen
• Temperature
• Blood pressure
• Heart rate
• ACVPU score (Alert, Confusion, Voice, Pain, Unconscious)

• Patients with increased NEWS score are at risk of sudden deterioration and/or cardiac arrest
• Any deterioration/sudden change in NEWS score will prompt patient review in accordance with the escalation strategy below

NEWS score =0

• Minimum 6-hrly observations

NEWS score =1-2

• 6-hrly observations
• Registered nurse to assess the patient
• Any irregular heart rate requires ECG and escalation
• Complete sepsis assessment as required
• Has the patient been assessed on the correct SpO₂ scale?
• Escalate concerns to the team managing to the patient (ward team/home team/outreach)

NEWS score =3-4

• 4-hrly observations
• Registered nurse to assess the patient
• Any irregular heart rate requires ECG and escalation
• Complete sepsis assessment as required
• Has the patient been assessed on the correct SpO₂ scale?
• Escalate concerns to the team managing to the patient (ward team/home team/outreach)

NEWS score =5-6

• Hourly observations
• Registered nurse to assess the patient
• Registered nurse to urgently escalate to appropriate team/doctor
  • if no response within 30 min escalate further i.e. registrar/consultant
• Complete sepsis assessment
• Monitor fluid balance hourly
• Transfer to higher monitoring area (if appropriate)
• Arrange transfer of care to level 2-3 facility as agreed by senior clinicians/critical care doctor
• Clinical staff to consider ceiling of care and suitability for CPR

NEWS score =7, 8, 9 or more

• Continuous observation as defined by treating clinician
• Registered nurse to assess the patient
• Complete sepsis assessment
• Obtain IV access and blood profile as required
• Monitor fluid balance hourly
• Urgent assessment by senior member of team managing the patient (ward team/home team/outreach)
• If no response within 10 min, escalate to registrar/consultant