INEWS chart
The official 2020 adult chart, as printed by the Department of Health. You take the readings and plot each one yourself: the dot in the right cell, both blood pressure arrows, the letter in the right row. Then the grey score rows, the total, the reassessment time and the escalation row. Every mark is checked against the INEWS V2 key, including the cells that decide a score (a pulse of 90 sits under the 90 line, 91 above it) and the values that catch people who learned NEWS2: any oxygen scores 3, heart rate 40 or below scores 2, systolic BP 250 or above scores 1.
How the INEWS chart is scored
INEWS (Irish National Early Warning System) is the adult observation chart used in Irish acute hospitals. Version 2 was published by the Department of Health in September 2020 as National Clinical Guideline No. 1 and replaced the 2013 chart. Seven parameters are scored 0 to 3 from the grey key rows, the scores are added to a total, and the total (or a single score of 3) sets the minimum observation frequency and who is informed. This is the key the trainer marks against, taken from the chart itself.
| Parameter | 3 | 2 | 1 | 0 | 1 | 2 | 3 |
|---|---|---|---|---|---|---|---|
| Respiratory rate (per min) | ≤8 | · | 9 to 11 | 12 to 20 | · | 21 to 24 | ≥25 |
| SpO₂ (%) | ≤91 | 92 to 93 | 94 to 95 | ≥96 | · | · | · |
| Inspired O₂ | · | · | · | Air | · | · | Any O₂ |
| Heart rate (per min) | · | ≤40 | 41 to 50 | 51 to 90 | 91 to 110 | 111 to 130 | ≥131 |
| Systolic BP (mmHg) | ≤90 | 91 to 100 | 101 to 110 | 111 to 249 | ≥250 | · | · |
| ACVPU | · | · | · | Alert | · | · | C, V, P or U |
| Temperature (°C) | ≤35.0 | · | 35.1 to 36.0 | 36.1 to 38.0 | 38.1 to 39.0 | ≥39.1 | · |
Three cells catch nurses who learned NEWS2 in the UK: any supplemental oxygen scores 3 (NEWS2 gives 2), a heart rate of 40 or below scores 2 (NEWS2 gives 3), and a systolic pressure of 250 or above scores 1 (NEWS2 gives 3 from 220). The chart also prints a sepsis prompt: consider sepsis when the total is 4 or more, or 5 or more on oxygen.
What the total means: the escalation protocol
| INEWS | Minimum observation frequency | Escalation |
|---|---|---|
| 0 to 1 | 6 hourly (first 24 hours following admission) then 12 hourly minimum | Nurse in charge (NiC) |
| 2 | 6 hourly | Nurse in charge (NiC) |
| 3 | 4 hourly | NiC and Team / On-call SHO |
| 4 to 6 | 1 hourly | NiC and Team / On-call SHO |
| ≥7 | ½ hourly | NiC and Team / On-call Registrar. Inform Team / On-call Consultant |
| Score of 3 in any single parameter, or score of 2 for HR ≤40 | ½ hourly or as indicated by patient condition | NiC and Team / On-call SHO |
A concern from a healthcare worker, the patient or the family sits above the table on the chart: the nurse in charge reviews and escalates regardless of the number. In the OSCE the examiner expects the reassessment time written on the chart and the right grade named in the ISBAR call, which is why the trainer asks for both.
The official chart
The chart, the full guideline and the summary are published by the Department of Health: Irish National Early Warning System (INEWS) Version 2 on gov.ie. The chart drawn above is the same document, so the cells you practise on are the cells you will see on the ward and at the station. For the hand-over that follows a high score, see the ISBAR trainer; for the sepsis screen the chart points to, the sepsis form. How the station itself runs is in Observations, INEWS and ISBAR.