The National Early Warning Score

The NEWS2 is based on a simple aggregate scoring system in which a score is allocated to physiological measurements, already recorded in routine practice, when patients present to, or are being monitored in hospital. Six simple physiological parameters form the basis of the scoring system:

 

  1. Respiration rate
  2. Oxygen saturation
  3. Systolic blood pressure
  4. Pulse rate
  5. Level of consciousness or new confusion*
  6. Temperature.

*The patient has new-onset confusion, disorientation and/or agitation, where previously their mental state was normal – this may be subtle. The patient may respond to questions coherently, but there is some confusion, disorientation and/or agitation. This would score 3 or 4 on the GCS (rather than the normal 5 for verbal response), and scores 3 on the NEWS system.

 

A score is allocated to each parameter as they are measured, with the magnitude of the score reflecting how extremely the parameter varies from the norm. The score is then aggregated. The score is uplifted by 2 points for people requiring supplemental oxygen to maintain their recommended oxygen saturation.

 

This is a pragmatic approach, with a key emphasis on system-wide standardisation and the use of physiological parameters that are already routinely measured in NHS hospitals and in prehospital care, recorded on a standardised clinical chart – the NEWS2 chart.

The NEWS2 chart update

The NEWS chart has been updated. In the NEWS2 chart:

  1. The recording of physiological parameters has been reordered to align with the Resuscitation Council (UK) ABCDE sequence
  2. The ranges for the boundaries of each parameter score are now shown on the chart
  3. The chart has a dedicated section (SpO2 Scale 2) for use in patients with hypercapnic respiratory failure (usually due to COPD) who have clinically recommended oxygen saturation of 88–92%
  4. The section of the chart for recording the rate of (L/min) and method/device for supplemental oxygen delivery has been improved xiv © Royal College of Physicians 2017
  5. The importance of considering serious sepsis in patients with known or suspected infection, or at risk of infection, is emphasised. A NEW score of 5 or more is the key trigger threshold for urgent clinical review and action
  6. The addition of ‘new confusion’ (which includes disorientation, delirium or any new alteration to mentation) to the AVPU score, which becomes ACVPU (where C represents confusion)
  7. The chart has a new colour scheme, reflecting the fact that the original red–amber–green colours were not ideal for staff with red/green colour blindness.

 

Chart 1 NEWS scoring system

Chart 2 NEWS threshold triggers

 

Source: Royal College of Physicians (2017), ISBN 978-1-86016-682-2, eISBN 978-1-86016-683-9

Reference:

Royal College of Physicians. National Early Warning Score (NEWS) 2: Standardising the assessment of acute-illness severity in the NHS. Updated report of a working party. London: RCP, 2017. 

www.rcplondon.ac.uk/projects/outputs/national-early-warning-score-news-2

 

* Important development for 2018

 

Association of Ambulance Chief Executives: (Sepsis NEWS2 addition) JRCALC 

  • Description: The sepsis guideline has been updated to include NEWS2
  • Date Update Posted Online: June 8, 2018
  • Section Title: Sepsis
  • Guideline Print Date: June 8, 2018

 

JRCAL Clinical Practice Guidelines: https://aace.org.uk/jrcalc-updates-2016/sepsis-news2-addition

 

You might also like this information on ATMISTT, which is one of many other useful articles avaialble on our website.

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