NEWS2

Question 1

Respiration rate (per minute)

Answer 1

≤8 (3)
9-11 (1)
12-20 (0)
21-24 (2)
≥25 (3)

Question 2

SpO2 Scale 1 (%)

Answer 2

≤91 (3)
92-93 (2)
94-95 (1)
≥96 (0)

Question 3

SpO2 Scale 2 (%)

Answer 3

≤83 (3)
84-85 (2)
86-87 (1)
88-92; ≥93 on air (0)
93-94 on oxygen (1)
95-96 on oxygen (2)
≥97 on oxygen (3)

Question 4

Air or oxygen?

Answer 4

oxygen (2)
air (0)

Question 5

Systolic blood pressure (mmHg)

Answer 5

≤90 (3)
91-100 (2)
101-110 (1)
111-219 (0)
≥220 (3)

Question 6

Pulse (per minute)

Answer 6

≤40 (3)
41-50 (1)
51-90 (0)
91-110 (1)
111-130 (2)
≥131 (3)

Question 7

Consciousness

Answer 7

alert (0)
CVPU (3)

Question 8

Temperature (°C)

Answer 8

≤35.0 (3)
35.1–36.0 (1)
36.1–38.0 (0)
38.1–39.0 (1)
≥39.1 (2)

Question 9

NEWS = 0
frequency of monitoring

Answer 9

minimum 12 hourly

Question 10

NEWS = 0
clinical response

Answer 10

continue routine NEWS monitoring

Question 11

NEWS = 1-4
frequency of monitoring

Answer 11

minimum 4-6 hourly

Question 12

NEWS = 1-4
clinical response

Answer 12

inform RN, who must assess the patient
RN decides whether increased frequency of monitoring and/or escalation of care is required

Question 13

NEWS = 3 in single parameter
frequency of monitoring

Answer 13

minimum 1 hourly

Question 14

NEWS = 3 in single parameter
clinical response

Answer 14

RN to inform medical team caring for the patient, who will review and decide whether escalation of care is necessary

Question 15

NEWS = total 5 or more (urgent response threshold)
frequency of monitoring

Answer 15

minimum 1 hourly

Question 16

NEWS = total 5 or more (urgent response threshold)
clinical response

Answer 16

RN to immediately inform the medical team caring for the patient
RN to request urgent assessment by a clinician or team with core competencies in the care of acutely ill patients
provide clinical care in an environment with monitoring facilities

Question 17

NEWS = total 7 or more (emergency response threshold)
frequency of monitoring

Answer 17

continuous monitoring of vital signs

Question 18

NEWS = total 7 or more (emergency response threshold)
clinical response

Answer 18

RN to immediately inform the medical team caring for the patient - this should be at least at specialist registrar level
emergency assessment by a team with critical care competencies, including practitioner(s) with advanced airway management skills
consider transfer of care to a level 2 or 3 clinical care facility (i.e. HDU or ICU)
clinical care in an environment with monitoring facilities