Home Sepsis scores National early warning score

National early warning score

251
0
Criteria Point Value
Respiratory Rate (breaths per minute)
≤8 3
9-11 1
12-20 0
21-24 2
≥25 3
Oxygen Saturation (%)
≤91 3
92-93 2
94-95 1
≥96 0
Any Supplemental Oxygen
Yes 1
No 0
Temperature in °C (°F)
≤35.0 (95) 3
35.1-36.0 (95.1-96.8) 1
36.1-38.0 (96.9-100.4) 0
38.1-39.0 (100.5-102.2) 1
≥39.1 (≥102.3) 2
Systolic BP
≤90 3
91-100 2
101-110 1
111-219 0
≥220 3
Heart Rate (beats per minute)
≤40 3
41-50 1
51-90 0
91-110 1
111-130 2
≥131 3
AVPU
A 0
V, P, or U 3

 

A low score (NEWS 1–4) should prompt assessment by a competent registered nurse who should decide if a change to frequency of clinical monitoring or an escalation of clinical care is required.

A medium score (NEWS of 5–6) should prompt an urgent review by a clinician skilled with competencies in the assessment of acute illness – usually a ward-based doctor or acute team nurse, who should consider whether escalation of care to a team with critical-care skills is required (ie critical care outreach team).

A high score (NEWS ≥7) should prompt emergency assessment by a clinical team/critical care outreach team with critical-care competencies and usually transfer of the patient to a higher dependency care area.