Family Name:
Date Date
Vital Signs Time (24 hour)
EWS
Time (24 hour)
Given Name: Gender:
≥ 36 RRT ≥ 36
Insert organisational logo AFFIX PATIENT LABEL HERE
or identifier here
Gender:
25-35 3 25-35 Date of Birth: NHI#:
AFFIX PATIENT LABEL HERE Respiratory Rate 21-24 2 21-24
(breaths/min)
12-20 0 12-20
ESCALATE CARE FOR ANY PATIENT YOU, THEY OR THEIR FAMILY ARE
9-11 9-11
NHI#:
1
write RR value in box
5-8 3 5-8 WORRIED ABOUT, REGARDLESS OF VITAL SIGNS OR EWS
≤4 RRT ≤4
Mandatory escalation pathway
Oxygen Room air 0 Room air
(L/min) Supplement (L/min) 2 Supplement (L/min)
Total Early Warning Score (EWS) Action
≥ 96 0 ≥ 96 144 characters max
Oxygen
EWS 1-5
Given Name:
Saturation (%) 94-95 1 94-95
write SpO2 value in 92-93 2 92-93
box ≤ 91 3 ≤ 91
Date of Birth:
Family Name:
96 characters max 274 characters max
Write if ≥ 140 RRT Write if ≥ 140
130s 3 130s EWS 6-7
120s 120s
2
110s 110s Acute illness or unstable
Heart Rate chronic disease
(bpm) 100s 100s
1
90s 90s
80s 80s 96 characters max
mark HR with X 70s 70s EWS 8-9
write value if off scale 60s
0
60s or any vital sign in red zone
50s 50s
Likely to deteriorate rapidly
40s 2 40s
30s RRT 30s
Adult Vital Signs Chart side 1
Write if ≥ 220 3 Write if ≥ 220
EWS 10+ 240 characters max
210s 210s
or any vital sign in blue zone
200s 200s
Blood Pressure 190s 190s
(mmHg) Immediately life
180s 180s
threatening critical illness
score systolic BP 170s 170s
value only 160s 0 160s
150s 150s Modification to Early Warning Score (EWS) Triggers
140s 140s
The EWS can be changed to prevent chronic disease incorrectly triggering escalation.
130s 130s
All modifications must be made in line with hospital policy and
120s 120s
110s 110s
regularly reviewed by the primary team.
100s 1 100s Ignore any modification that is not signed and dated.
90s 2 90s Vital sign Accepted values and Date and Name and contact
Duration
80s 80s (use abbreviation) modified EWS time (hours) details
3
70s 70s
/ /
60s 60s
RRT :
50s 50s
≥ 39s 2 ≥ 39s Reason:
Temperature 38s 1 38s
(oC) / /
37s 37s
0
36s 36s :
mark Temp with X
write value if off scale 35s 1 35s
Organisational document identifier
≤ 34s 2 ≤ 34s
Reason:
Alert 0 Alert
Level Of Voice Voice
/ /
Consciousness Pain
3
Pain
:
mark LOC with Unresponsive RRT Unresponsive
Reason:
EARLY WARNING SCORE TOTAL EWS TOTAL
/ /
NOT FOR CPR NOT FOR RRT :
Any treatment limitations must be documented in the patient’s clinical record.
A full set of vital signs with corresponding EWS must be taken and calculated each
time at a frequency stated in hospital policy. If there is no timely response to your
request for review, escalate to the next coloured zone.
Family Name:
Date Date
Vital Signs Time (24 hour)
EWS
Time (24 hour)
Given Name: Gender:
≥ 36 RRT ≥ 36
Insert organisational logo AFFIX PATIENT LABEL HERE
or identifier here
Gender:
25-35 3 25-35 Date of Birth: NHI#:
AFFIX PATIENT LABEL HERE Respiratory Rate 21-24 2 21-24
(breaths/min)
12-20 0 12-20
ESCALATE CARE FOR ANY PATIENT YOU, THEY OR THEIR FAMILY ARE
9-11 9-11
NHI#:
1
write RR value in box
5-8 3 5-8 WORRIED ABOUT, REGARDLESS OF VITAL SIGNS OR EWS
≤4 RRT ≤4
Mandatory escalation pathway
Oxygen Room air 0 Room air
(L/min) Supplement (L/min) 2 Supplement (L/min)
Total Early Warning Score (EWS) Action
Oxygen ≥ 96 0 ≥ 96
EWS 1-5
Given Name:
Saturation (%) 94-95 1 94-95
write SpO2 value in 92-93 2 92-93
box ≤ 91 3 ≤ 91
Date of Birth:
Family Name:
Write if ≥ 140 RRT Write if ≥ 140
130s 3 130s EWS 6-7
120s 120s
2
110s 110s Acute illness or unstable
Heart Rate chronic disease
(bpm) 100s 100s
1
90s 90s
80s 80s
mark HR with X 70s 70s EWS 8-9
write value if off scale 60s
0
60s or any vital sign in red zone
50s 50s
Likely to deteriorate rapidly
40s 2 40s
30s RRT 30s
Adult Vital Signs Chart side 2
Write if ≥ 220 Write if ≥ 220
3
EWS 10+
210s 210s
or any vital sign in blue zone
200s 200s
Blood Pressure 190s 190s
(mmHg) Immediately life
180s 180s
threatening critical illness
score systolic BP 170s 170s
value only 160s 0 160s
150s 150s Modification to Early Warning Score (EWS) Triggers
140s 140s
The EWS can be changed to prevent chronic disease incorrectly triggering escalation.
130s 130s
All modifications must be made in line with hospital policy and
120s 120s
110s 110s
regularly reviewed by the primary team.
100s 1 100s Ignore any modification that is not signed and dated.
90s 2 90s Vital sign Accepted values and Date and Name and contact
Duration
80s 80s (use abbreviation) modified EWS time (hours) details
3
70s 70s
/ /
60s 60s
RRT :
50s 50s
≥ 39s 2 ≥ 39s Reason:
Temperature 38s 1 38s
(oC) / /
37s 37s
0
36s 36s :
mark Temp with X
write value if off scale 35s 1 35s
Organisational document identifier
≤ 34s 2 ≤ 34s
Reason:
Alert 0 Alert
Level Of Voice Voice
/ /
Consciousness Pain
3
Pain
:
mark LOC with Unresponsive RRT Unresponsive
Reason:
EARLY WARNING SCORE TOTAL EWS TOTAL
/ /
NOT FOR CPR NOT FOR RRT
:
Any treatment limitations must be documented in the patient’s clinical record.
A full set of vital signs with corresponding EWS must be taken and calculated each
time at a frequency stated in hospital policy. If there is no timely response to your
request for review, escalate to the next coloured zone.
