You've just taken the vitals of a patient lying seemingly asleep. Their blood pressure is lower than normal, and their respiratory rate is 22. Is the patient merely "a bit off" or are they actually "crashing"? Guessing is never a guarantee and is quite stressful. However, the NEWS2 score luckily provides clear and data-driven answers.
Clinical intuition is vital, but it's oftentimes hard to quantify. When you call a doctor or RRT, you need objective data to support your claim. You may have a "gut feeling” that it means something. However, a gut feeling combined with a NEWS2 score of 6 is undeniable.
Standardized NEWS2 scores provide nurses with a universal language for patient deterioration. Here is a quick guide to accessing the NEWS2 score on the floor, including how to calculate it swiftly, what it really means, and what to do depending on the score.
Unlike the UK's NHS, which mandates NEWS2, US hospitals vary. You might see MEWS (Modified Early Warning Score), PEWS (for pediatrics), or the Rothman Index. However, NEWS2 is becoming the “gold standard” for sepsis protocols because—unlike MEWS—it accounts for patients with COPD who live at lower oxygen saturations.
What exactly is a NEWS2 score?
The National Early Warning Score (NEWS2) is a standardized "scoring system" that assists nurses and other clinicians in spotting and quickly assessing the severity of acute illness and patient deterioration early in patients over the age of 16. Think of it like a credit score for acute sickness; the higher the value, the higher the risk.
Thoroughly understanding the NEWS2 score begins with recognizing its role as a safety net. It takes the guesswork out of triage and bedside monitoring by assigning a numerical value to physiological changes. NEWS2 may be your greatest ally in early detection, as it identifies patterns that might be missed when examining individual vitals in isolation.
While facilities across the United Kingdom have entirely transitioned from older systems, such as the MEW Score, adoption in the United States remains voluntary and hospital-specific.
While the Modified Early Warning Score (MEWS) was a good starting point, NEWS2 is far more sensitive for sepsis and standardizes the language for all healthcare professionals, including nurses, doctors, and respiratory therapists. By incorporating oxygen saturation scales for patients with hypercapnic respiratory failure, NEWS2 enables a level of precision that older systems simply cannot match.
The 7 components: How to calculate NEWS2 score in 60 seconds
While Epic, Cerner, or your facility's electronic health record (EHR) will likely auto-calculate this score in the “Best Practice Advisory” (BPA) column, you must validate it. Computers often can't distinguish between a patient on “Room Air” vs. “2L Nasal Cannula” without your input. If you input the wrong oxygen status, the automated score will be dangerously wrong.
You'll score points (0-3) for abnormalities in these NEWS2 score components:
- Respiratory rate: The respiratory rate is often the first and most sensitive sign of clinical decline.
- Oxygen saturations: This measurement includes Scale 2 (SpO2 88-92%) specifically for COPD retainers. This prevents “alarm fatigue” by stopping the system from flagging a stable COPD patient as “crashing” just because their sats are 90%—a common flaw in the older MEWS system.
- Systolic blood pressure: A low systolic blood pressure reading may indicate late-stage shock or severe dehydration.
- Pulse rate: Occurrences of tachycardia and bradycardia provide immediate clues about cardiac stress.
- Level of consciousness: Unlike the standard GCS or “Alert & Oriented” checks, the NEWS2 scale uses a simpler ACVPU scale. This focuses specifically on New Confusion, which is often the earliest sign of sepsis or hypoxia that the GCS may miss.
- Temperature: Monitoring is essential because fever or hypothermia can both be critical indicators of a systemic response.
- Supplemental oxygen: This field requires a simple "yes" or "no" regarding whether the patient requires oxygen to maintain saturations.
Calculating a score is a rapid-fire process once you have the vitals in hand. Simply assign a point value from 0 to 3 based on how far each measurement deviates from the normal range. A "0" represents a stable, normal vital sign, while a "3" represents a significant physiological derangement.
Performing a NEWS2 score calculation at the bedside requires that you tally these points to get a single total. For example, if a patient has a high respiratory rate (2 points), a high heart rate (1 point), and new confusion (3 points), their total score is 6. This process takes less than a minute but provides significant clinical clarity.
NEWS2 score interpretation and recommended action
Converting mere numbers into a clinical decision is where your nursing skills truly shine. To make it really easy, think of the NEWS2 score action plan as a follow-on system that dictates your pace and urgency.
Score 0–3 (low risk): Green light
Patients who fall into this range are generally stable and responding well to their current treatment plan.
Many clinicians ask, "What is a good NEWS2 score?" Generally, a score of 0 represents a stable baseline, while scores of 1–4 require routine monitoring. The primary course of action here would be to maintain the status quo and continue with routine vital sign checks, typically every four to six hours, depending on your facility policy.
Remember, even with a "green" score, a sudden change of 2 points from a patient's baseline still warrants a closer look.
Score 3 in one parameter or 5–6 total (medium risk): Yellow light
Watch closely, the patient at this level may be at a risk of severe deterioration. If a patient scores a 3 in any particular category, such as a very high respiratory rate, even if their total score is low, close attention is recommended.
Yellow light: Escalate the situation to the attending physician, hospitalist, or mid-level provider. Now it is suggested to increase the frequency of vitals to at least every hour and perform a thorough, head-to-toe assessment to find the source of the derangement.
Score 7+ (high risk): Red light
Scoring 7 or higher indicates a clinical emergency, where the patient is at grave risk of severe illness or even death. At this stage, you do not wait to see if things improve.
Immediate action calls for a rapid response team or a physician STAT. The patient will now require continuous monitoring and likely an escalation in the level of care, such as a transfer to an intensive care unit (ICU) or a progressive care unit (PCU)/step-down unit.
How to chart your received NEWS2 score
Charting efficiently isn't just about extensive data entries; rather, it’s about creating a clear, rapid, and defensive summary of your clinical judgment. Knowing how to chart a NEWS2 score properly provides a roadmap of the patient's journey and your appropriate response.
Documenting the score is your legal safety net. If a patient crashes and you are deposed, being able to show “I notified the provider when the NEWS2 shifted from 2 to 6” proves you followed the standard of care.
Charting for communication
Using the NEWS2 score during a handoff or call to a provider (MD, DO, NP, or PA) effectively transforms the situation from merely a concern into a potentially objective reality. Upon calling the doctor, express concern coherently, rather than simply stating, "I'm worried about the patient in 302." Rather, say, "Mr. Hank in room 302 just jumped from a NEWS2 of 1 to a 7. I need you at the bedside now." Persistent and confident language removes ambiguity and prompts a faster clinical response because the urgency is clearly defined by data and the tone of your voice.
Charting for sepsis
In the US, meeting CMS Sepsis Core Measures (SEP-1) is critical for hospital accreditation. A NEWS2 score of 5+ is often the earliest trigger to initiate the “3-Hour Sepsis Bundle” (Lactate, Blood Cultures, Antibiotics), ensuring your facility's compliance and your patient's safety. If you chart a "NEWS2 = 5," your next note should ideally read, "informed physician, recommended sepsis workup per protocol."
Proper documentation demonstrates that you have pieced together the puzzle, differentiating between physiological changes and potentially life-threatening illnesses. Protecting the patient by ensuring they receive early intervention not only guards your license but also proves that you acted suitably based on the data you provided.
From "gut feeling" to "data-driven"
The NEWS2 scoring system will never replace a nurse's clinical judgment. In fact, it teaches you a common medical language to assist you in communicating risk far more efficiently.
Moving away from vague senses of unease to a specific numerical value provides your patients with a higher standard of safety. Comprehending this system enables you to walk into any unit with the certainty that you can competently identify and articulate patient needs with precision, turning every set of vitals into an actionable insight and ensuring that your expertise is backed by a globally recognized framework.
The ability to utilize the NEWS2 scoring system is one of many skills that distinguish a top-tier nurse. Facilities are constantly looking for medical professionals who bring this level of expertise to every shift they work.
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