Policy briefing

National Early Warning Score update

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

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

Picture: Jim Varney

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 2017. The updated version improves escalation in patients with chronic hypoxaemia and includes acute delirium or confusion within assessments.

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, NHE England says. Through standardisation of the NEWS, the number of patients whose conditions deteriorate while in hospital could be reduced, and potentially save more than 1,800 lives a year, NHS England says.

Where NEWS is used

The NEWS can be used in all patients aged over 16, 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 judgment should always be used, even if the NEWS is normal.

Implications for nurses

Under the system, patients are assessed on breathing rate, pulse rate, systolic blood pressure, temperature, level of consciousness 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 one to four leads to an assessment by a registered nurse, a medium score of between five and 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

Dawne Garrett, RCN professional lead for older people and dementia care

‘Standardising the use of the NEWS tool across England means all healthcare staff will be speaking a common language, which is a positive move and can improve patient safety. The tool can be useful for picking up patients, particularly those in the acute sector, who are deteriorating.

‘Those who work with older people need to be aware that, particularly for those with multiple complex conditions, their baseline observations can be different, and that can be an important consideration when assessing patients.

'Having a knowledge of a patient’s baseline observations when they are at their most well is useful in this case, as many older people with complex needs will score highly. Knowing the patient means that the nuances of the individual person can be considered and clinical judgment used.’


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