The National Early Warning Score (NEWS2) is a system used in the UK to quickly identify patients at risk of deterioration, particularly in hospital settings. It helps healthcare professionals to provide timely interventions, which can save lives. Here’s a straightforward guide to understanding and using NEWS2. When you get to the UK, you will learn this a lot so why not learn ahead now? There's no big deal about it.

What is NEWS2?

NEWS2 is a scoring system used to assess the severity of illness and monitor the condition of patients. It involves checking six physiological parameters and assigning a score based on how far these parameters deviate from normal ranges. In simple terms, it's a way that UK healthcare workers record their vital signs so that they can make sense of it using a scoring system.

The Six Parameters

1. Respiratory Rate (RR): How many breaths a patient takes per minute.

2. Oxygen Saturation (SpO2): The percentage of oxygen in the blood.

3. Systolic Blood Pressure (SBP):  The pressure in the arteries when the heart beats.

4. Heart Rate (HR): The number of heartbeats per minute.

5. Level of Consciousness (LOC): How awake and responsive a patient is, often measured using the AVPU scale (Alert, Voice, Pain, Unresponsive). There is also a ‘C’ for confusion but it is only meant for patient who have only suffered a NEW ONSET CONFUSION.

6. Temperature: The patient’s body temperature.

NEWS2 VIDEO

Link to video: https://youtu.be/Sse4FXJWx8w

CLICK HERE FOR A LINK TO THE NEWS2 CHART: CLICK ME

How to Calculate NEWS2

The first thing I want you to know is that there are two scales. We have  Scale 1 and 2 of NEWS2 specifically referring to the oxygen saturation (SpO2).

SpO2 Scale 1: This is the standard scale used for the majority of patients. It assesses oxygen saturation levels, aiming for a target saturation of 96-100%. Scores are assigned based on how far the patient’s SpO2 deviates from this range.

SpO2 Scale 2: This scale is used for patients with hypercapnic respiratory failure, typically associated with conditions like chronic obstructive pulmonary disease (COPD). For these patients, the target SpO2 is lower, around 88-92%, to avoid worsening their hypercapnia. The scoring system is adjusted accordingly to reflect these different target ranges. In short, scale 2 is indicated for patient who require adjusted oxygen saturation levels. In some hospitals, it requires a clear indication that patient is on scale 2 before scale 2 is used to record their observations.

NB: You can only use one scale at a time. You cannot use scale 1 and 2 on a particular time of assessment. 

Each parameter is measured and scored as follows using the colored chat:

- Respiratory Rate:

  - 12-20 breaths per minute = 0 points

  - 9-11 or 21-24 breaths per minute = 1 point

  - 25 or more breaths per minute = 3 points

- Oxygen Saturation (SpO2):

  - 96% or more = 0 points

  - 94-95% = 1 point

  - 92-93% = 2 points

  - 91% or less = 3 points

- Systolic Blood Pressure (SBP): (that is the only one that gives you a score on the chart, ignore the diastolic score)

- 220 and above = 3 points

  - 111-219 mmHg = 0 points

  - 101-110 mmHg = 1 point

  - 91-100 mmHg = 2 points

  - 90 mmHg or less = 3 points

- Heart Rate (HR):

  - 51-90 beats per minute = 0 points

  - 41-50 or 91-110 beats per minute = 1 point

  - 111-130 beats per minute = 2 points

  - 131 or more beats per minute = 3 points

- Level of Consciousness (LOC):

  - Alert = 0 points

  - Responds to Voice = 3 points

  - Responds to Pain = 3 points

  - Unresponsive = 3 points

- Temperature:

  - 36.1-38.0°C = 0 points

  - 35.1-36.0°C = 1 point

  - 38.1-39.0°C = 1 point

  - 35.0°C or lower = 3 points

  - 39.1°C or higher = 3 points

Using the NEWS2 Score

1. Calculate the total NEWS2 score by adding the points from each parameter.

2. Interpret the score:

   - 0-4: Low risk – Routine monitoring

   - 5-6: Medium risk – Increased frequency of observations and consider medical review.

   - 7 or more: High risk – Urgent review by a senior clinical decision-maker.

Practical Tips

- Documentation: Record the measurements accurately and regularly on the NEWS2 chart.

- Escalation: Follow the escalation protocol based on the score. If the score is high, inform the appropriate medical team immediately.

- Training: Familiarize yourself with the equipment used to measure each parameter and practice using it.

- Communication: Clearly communicate the NEWS2 score and the patient’s condition to other healthcare professionals during handovers or when seeking assistance.

Importance of NEWS2

- Early Detection: Helps in early identification of patient deterioration, enabling timely intervention.

- Standardization: Provides a standardized approach to patient monitoring across different healthcare settings.

- Improved Outcomes: Contributes to better patient outcomes by ensuring prompt treatment.

Let's fill the chart using this NEW2 chart:

Patient A: on scale 1

Respiratory rate: 22 breaths per minute

Oxygen saturation: 95%

Blood pressure: 135/65 mmHg

LOC = Alert

Heart rate: 88 beats per minute

Temperature: 37.1°C  

Solution: RR = 2 points; O2 sats equals 1 point. no scores for others: total 3 points

SAMPLE OF A FILLED NEWS2 CHART: CLICK ME

WHAT TO DO WITH THE SCORE:  CLICK ME

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