Early Warning Score (EWS) in Nursing: Essential Guide for Patient Assessment

What is Early Warning Score (EWS)?

Early Warning Score is a tool used by nursing staff to quickly determine the degree of illness of a patient. It is based on six cardinal vital signs.

The 6 Key Parameters of EWS:

Nurses must monitor these six signs to calculate the score:
Respiratory Rate: Checking for tachypnea or bradypnea.
Oxygen Saturation (SpO_2): Monitoring the level of oxygen in the blood.
Body Temperature: Checking for fever or hypothermia.
Systolic Blood Pressure: Monitoring for hypertension or shock.
Heart Rate (Pulse): Checking for tachycardia or bradycardia.
Level of Consciousness (AVPU): Is the patient Alert, or responding to Voice/Pain, or Unresponsive?

Why EWS is Important for Nurses?

Early Detection: It helps in identifying a deteriorating patient before a cardiac arrest occurs.
Timely Intervention: Nurses can call the RRT (Rapid Response Team) or doctor immediately based on the score.
Standard Communication: It provides a common language between nurses and doctors.

EWS Scoring Action Plan:

Score 0-1: Low Risk – Continue routine observation.
Score 3-4: Medium Risk – Increase frequency of monitoring and inform the Ward In-charge.
Score 5 or more: High Risk – Immediate medical review required. Call the doctor or ICU team.

Detailed Guide to Early Warning Score (EWS) for Nurses

Introduction

The Early Warning Score (EWS) is a clinical tool used by healthcare professionals, especially nursing officers, to monitor a patient’s condition and identify early signs of clinical deterioration. By tracking vital signs, nurses can predict potential life-threatening events like cardiac arrest or organ failure before they happen.

Why do we use EWS in the Hospital?
In a busy hospital or ICU, a patient’s condition can change rapidly. EWS provides a “track and trigger” system.

Track: Regularly monitoring vital signs.
Trigger: Alerting the medical team when the score reaches a certain threshold.

The NEWS2 Scoring System (National Early Warning Score)
Most modern hospitals now use NEWS2. It focuses on 6 physiological parameters:

Respiratory Rate: Normal range is 12–20 breaths per minute.
A very high or very low rate indicates respiratory distress.

Oxygen Saturations (SpO_2): Essential for patients with respiratory conditions like COPD.
Target saturation is usually 94–98%, but for some patients, it is 88–92%.

Systolic Blood Pressure: A drop in systolic BP (Hypotension) is often a late sign of shock.
Pulse Rate: * Checking for tachycardia (fast heart rate) or bradycardia (slow heart rate).

Level of Consciousness: * Using the ACVPU scale: Alert, Confusion (New), Voice, Pain, Unresponsive.

Temperature: * Monitoring for infection (Sepsis) or hypothermia.

Nursing Responsibilities & Action Plan

As a nursing officer, your action depends on the total score calculated:
Low Score (1–4):
Assess the patient every 4–6 hours.
Inform the shift in-charge.
Ensure all vitals are recorded accurately.

Medium Score (5–6 or a score of 3 in any single parameter):
Increase monitoring frequency to every 1 hour.
Inform the resident doctor immediately.
Prepare emergency equipment (Oxygen, IV fluids).

High Score (7 or more):

This is a Medical Emergency.
Call the Rapid Response Team (RRT) or ICU Registrar.
Continuous monitoring of vital signs.
Initiate emergency life support if required.
Benefits of EWS for Nursing Students and Staff
Reduces Mortality: Early detection saves lives.
Better Communication: Using a score makes it easier to explain the patient’s condition to a doctor over the phone.
Improved Patient Safety: It ensures that no “silent” deterioration goes unnoticed during the night shift.

Conclusion

Mastering the EWS/NEWS2 system is vital for every nursing professional. It is not just about filling out a chart; it is about critical thinking and taking fast action to ensure patient safety.

Practical Tips for Nurses when Calculating EWS
As a Nursing Officer, you should keep these practical points in mind while recording the Early Warning Score:

Don’t rely only on Machines: Sometimes monitors give wrong readings (especially SpO_2 if the probe is loose). Always check the patient manually.
Observe the Skin: Along with the score, check the patient’s skin color (cyanosis) and moisture (diaphoresis).
Document Immediately: Don’t wait for the end of the shift to record the EWS. Delayed documentation can lead to delayed treatment.

In my experience as a nursing staff in the ICU, I have seen many cases where EWS helped us save lives…

Communication is Key: When calling a doctor for a high EWS, use the SBAR (Situation, Background, Assessment, Recommendation) technique.

Frequently Asked Questions (FAQs)

What is the difference between EWS and NEWS2?
EWS is a general term for early warning systems, while NEWS2 is the updated national standard used globally for better accuracy in identifying sepsis and oxygen requirements.
Can a high EWS score predict Sepsis?
Yes, a rising EWS score along with an increased temperature is often the first indicator of Sepsis in clinical settings.

What should a nurse do if the EWS is 5?
A score of 5 is a “Red Flag.” The nurse should immediately inform the attending physician and increase the frequency of vital monitoring to every 30-60 minutes.

Author’s Note (Original Content):

“This educational content is curated by BexyHub based on standard clinical nursing protocols and my personal experience as a Nursing Professional. All the information provided is written in a simplified manner to help nursing students and staff. This is 100% original and human-written content, intended for educational purposes only. No part of this article has been copied from copyrighted books or websites.”

Bedside Nursing se Digital Education tak

“Namaste, main Deepak Kumar hoon. Maine apne nursing career ki shuruat ek junoon ke saath ki, jahan maine GNM, Post BSc Nursing, aur phir MSc Nursing ki shiksha poori ki. Mera asli imtehaan tab shuru hua jab maine ICU (Intensive Care Unit) mein ek Nursing Officer ke roop mein kadam rakha.
ICU ki wo bhag-daur, ventilator management, aur critical patients ki har dhadkan par nazar rakhne ke anubhav ne mujhe sikhaya ki nursing sirf ek kitab nahi, balki ek zimmedari hai.
Maine Bexyhub ki shuruat isliye ki taaki main apne is clinical tajurbe ko un students tak pahuncha sakun jo competitive exams (NORCET, AIIMS, State PSC) ki taiyari kar rahe hain. Meri har post ke piche ghanto ki research aur mera saalo ka hospital experience hota hai. Mera maqsad sirf content dena nahi, balki aapko ek behtar medical professional banana hai.”