Policy briefing

Updated National Early Warning Score

In December 2017, the Royal College of Physicians updated the National Early Warning Score to improve identification of acutely ill patients

In December 2017, the Royal College of Physicians updated the National Early Warning Score to improve identification of acutely ill patients

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Essential facts

The National Early Warning Score (NEWS) was developed by the Royal College of Physicians to improve the identification of acutely ill patients, including those with sepsis. A score is allocated to six physiological measurements, already recorded in routine practice, to gain an aggregate overall score.

The original NEWS was published in 2012, with a new version, NEWS2, launched in December. The updated version improves escalation in patients with chronic hypoxaemia and includes acute delirium or confusion in assessments. The recording of physiological parameters has been reordered to align with the Resuscitation Council (UK) ABCDE sequence.

What’s new

Every hospital and ambulance service in England has been asked to use the NEWS system by March next year (2019). Already used by 70% of hospitals, increasing this further will mean NHS staff who move between trusts are using a consistent set of measures for diagnosing patients. Through standardisation of the NEWS, the number of patients who deteriorate while in hospital could be reduced, potentially saving more than 1,800 lives a year, NHS England says.

Where NEWS is used

The NEWS can be used in all patients over 16 years old, except pregnant women, and across all healthcare settings. It is particularly useful when patients are transferred from one setting to another to ensure there is a clear understanding of the patient’s clinical state, risk of deterioration and prognosis. Clinical judgement should always be used, even if the NEWS is normal.

Paramedics have been told that NEWS should be used for all pre-hospital patients who are ill or at risk of deteriorating, including those suspected of having sepsis. But it should not be used as the sole criteria for prioritisation of patients being admitted to hospital via ambulance services.

Implications for nurses

Under the system, patients are assessed on breathing rate, pulse rate, systolic blood pressure, temperature, level of consciousness or new confusion and oxygen saturation. The results are plotted on a NEWS chart, which gives a score for each measure. The combined number then shows the level of clinical care needed and the risk of deterioration.

A low score, of between one and four, leads an assessment by a registered nurse, a medium score, of five or six, would prompt an urgent review from an acute clinician, such as a ward-based doctor, and a high score, of seven or more, would see an emergency assessment by a critical care team and a likely patient transfer to a high-dependency unit.

Expert comment

Suman Shrestha, RCN co-professional lead for acute, emergency and critical care

‘I have been using NEWS at my hospital for the past few years, and it is a really good system for keeping patients safe by helping healthcare assistants (HCAs), nurses and doctors to escalate patients appropriately.

‘In most hospitals, it is the HCAs who are doing the observations, and NEWS provides clear guidance on what action they should take depending on the score.

‘If the same system is used across the healthcare system, it means that it becomes standard language and improves communications between departments and settings, helping healthcare professionals know how severely unwell a patient may be. 

‘There is currently a drive to introduce it in the community, as it can be very useful to identify deteriorating patients with conditions such as sepsis.’


Further information

RCNi articles

Fox A, Elliot N (2015) Early warning scores: a sign of deterioration in patients and systems. Nursing Management

Maxwell E (2018) Turning risk tools into life savers. Nursing Management

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