The NEWS 2 chart is the standard observation chart used across the NHS to record a patient’s vital signs and turn them into a single early warning score. NEWS2 stands for National Early Warning Score 2, and the chart was developed by the Royal College of Physicians (RCP) to help staff spot acute illness and deterioration early and respond in a consistent way.
If you are a nurse, an international nurse joining the NHS, or a candidate preparing for the NMC OSCE, you will need to read this chart accurately. This guide explains what is recorded, how the score is built, what Scale 2 is, how monitoring and escalation relate to the score, and where the official chart lives. It also explains how NEWS2 appears in NMC OSCE materials.
Educational use only. This guide is written by Medax OSCE Academy for learning. It does not replace the official RCP chart, your employer’s policy or clinical judgement. Medax is not affiliated with, endorsed by or approved by the NHS, NHS England, the NMC or the Royal College of Physicians.
What Is a NEWS2 Chart?
A NEWS2 chart is a colour-coded observation chart. Staff record routine physiological measurements on it, score each one, and add the scores together. The total helps the team judge how unwell the patient may be and how urgently to respond.
The RCP describes NEWS as a simple aggregate scoring system built on measurements that are already routinely taken. NHS England and NHS Improvement endorsed it as the recommended early warning system for adults in the NHS in England. The RCP report also notes it should support, not replace, clinical judgement.
In short: the chart tracks trends over time, flags deterioration early and gives everyone a common language.
What Does NEWS2 Stand For?
NEWS2 stands for National Early Warning Score 2. The “2” marks the updated version published in 2017, which refined the original NEWS launched in 2012. The main changes were:
- a separate oxygen saturation scoring scale (Scale 2) for patients with confirmed hypercapnic respiratory failure;
- “new confusion” added to the consciousness assessment, changing AVPU to ACVPU;
- reordering of parameters to follow the ABCDE approach;
- a clearer emphasis on the link between a score of 5 or more and possible sepsis;
- a redesigned colour scheme that works better for people with red–green colour blindness.
What Is Recorded on a NEWS2 Chart?
Six physiological parameters are scored, plus a weighting for supplemental oxygen. The chart also records the oxygen delivery device and flow rate.
| Parameter | What is recorded | Notes |
|---|---|---|
| Respiration rate | Breaths per minute | Scored high or low |
| Oxygen saturation (SpO₂) | Percentage, using Scale 1 or Scale 2 | Scale choice is a clinical decision (see below) |
| Air or oxygen | Whether the patient is on supplemental oxygen | Adds 2 points if on oxygen |
| Systolic blood pressure | mmHg | Only systolic is scored |
| Pulse rate | Beats per minute | Scored high or low |
| Consciousness | ACVPU: Alert, new Confusion, Voice, Pain, Unresponsive | Anything other than Alert scores 3 |
| Temperature | °C | Both high and low temperatures score |
The RCP says the core scoring section of the chart should stay consistent nationally, while the rest of the chart may be adapted locally (for example, to record pain or urine output).
How Does NEWS2 Scoring Work?
Each parameter scores between 0 and 3. The further a reading is from the normal range, the higher the score. The six parameter scores are added, and 2 points are added if the patient needs supplemental oxygen to maintain their prescribed saturation. The total is the aggregate NEWS2 score.
The table below summarises the RCP Scale 1 scoring. Always check readings against the official RCP chart; this table is a learning summary.
| Parameter | 3 | 2 | 1 | 0 | 1 | 2 | 3 |
|---|---|---|---|---|---|---|---|
| Respiration rate | ≤8 | 9–11 | 12–20 | 21–24 | ≥25 | ||
| SpO₂ Scale 1 (%) | ≤91 | 92–93 | 94–95 | ≥96 | |||
| Air or oxygen | Air | Oxygen | |||||
| Systolic BP (mmHg) | ≤90 | 91–100 | 101–110 | 111–219 | ≥220 | ||
| Pulse (bpm) | ≤40 | 41–50 | 51–90 | 91–110 | 111–130 | ≥131 | |
| Consciousness | Alert | C, V, P or U | |||||
| Temperature (°C) | ≤35.0 | 35.1–36.0 | 36.1–38.0 | 38.1–39.0 | ≥39.1 |
Two points people often miss:
- A single red score. A score of 3 in any one parameter is treated as a trigger for urgent review, even if the total is low.
- New confusion scores 3. If it is unclear whether confusion is new, the RCP says to treat it as new until confirmed otherwise.
Some patients have naturally low blood pressure or a low resting pulse, for example, and the RCP notes that other information can explain unusual values. That is why the score is an aid to assessment, not a verdict.
What Is NEWS2 Scale 2?
Scale 2 is a separate oxygen saturation scoring scale on the NEWS2 chart. It is for patients who have confirmed hypercapnic respiratory failure (often type 2 respiratory failure, most commonly related to COPD) and whose prescribed target saturation is 88–92%.
Why it exists: patients with hypercapnic respiratory failure can be harmed if given too much oxygen. Under Scale 1, a target of 88–92% would score as abnormal and could push staff to give more oxygen than is safe. Scale 2 adjusts scoring so that 88–92% scores 0.
The RCP’s rules for using it:
- Use it only for patients confirmed to have hypercapnic respiratory failure on blood gas analysis, in a previous or current admission.
- A competent clinical decision maker must choose it, and the decision must be recorded in the clinical notes.
- In all other cases, use Scale 1.
- The scale you are not using should be clearly crossed out on the chart.
Practical point: Scale 2 is not something to switch to because a patient has COPD or a low reading. If you are unsure which scale applies, ask a senior clinician and follow local policy.
NEWS2 Monitoring Frequency
The RCP recommends that the NEWS2 score informs how often observations are done, and that the frequency is recorded on the chart. The RCP’s recommended minimums are:
| NEWS2 result | RCP recommended minimum frequency |
|---|---|
| Aggregate score 0 | 12-hourly |
| Aggregate score 1–4 | 4–6 hourly |
| Aggregate score 5–6, or a single red score | At least hourly, until reviewed and a plan of care is documented |
| Aggregate score 7 or more | Continuous monitoring of vital signs |
The RCP adds that a competent clinical decision maker may choose more or less frequent monitoring when appropriate. Your Trust’s policy sets what you actually do. Some patients have individual monitoring plans, and the RCP also says routine NEWS recording may be inappropriate in some situations, for example on an end-of-life pathway. Such decisions should be discussed with the patient or family and documented.
NEWS2 Chart Escalation
Escalation means passing a concern to someone with the right skills to assess and act, at the right speed. The RCP links the type of response to the score:
| NEWS2 result | Clinical risk | RCP-described response |
|---|---|---|
| Aggregate 0–4 | Low | Ward-based response. For 1–4, a registered nurse assesses and decides whether monitoring or care needs to change |
| Single red score (3 in one parameter) | Low–medium | Urgent ward-based response, usually a ward-based doctor, to find the cause |
| Aggregate 5–6 | Medium | Key threshold for urgent response by a clinician or team competent in assessing acutely ill patients, who decide on escalation to critical care skills |
| Aggregate 7 or more | High | Urgent or emergency response by a team with critical care competencies, usually with transfer to a higher-dependency area |
Three principles matter more than any table:
- Concern overrides the score. The RCP states that any concern about a patient should prompt urgent clinical review, whatever the NEWS2 score.
- Local policy decides the mechanism. Who you call, how, and how fast are set by your Trust. Learn it on day one.
- Think sepsis. A score of 5 or more in a patient with suspected infection should prompt urgent assessment for sepsis by a clinical team competent in managing it.
Record the response on the chart as well. The RCP recommends this so there is a continuous record of actions taken.
What Patient Group Is NEWS2 Used For?
The NEWS2 chart is used for adult patients, aged 16 and over. The RCP recommends it for:
- initial assessment and continuing monitoring in hospital;
- emergency departments;
- prehospital assessment, for example by ambulance services.
It should not be used in children under 16 or in women who are pregnant, because physiological responses to illness are different. (Children’s services use paediatric early warning tools instead. Pregnant women are assessed with obstetric early warning scores. Follow your local policy for both.)
Use with caution: the RCP notes NEWS2 may be unreliable in patients with spinal cord injury, especially tetraplegia or high paraplegia, because the autonomic nervous system is affected.
NEWS2 Chart PDF and Printable Resource
The official NEWS2 charts are published free by the RCP, and the RCP asks that they be reproduced in colour, unmodified and credited to the RCP. To get the current chart, use the RCP’s NEWS2 page (linked in the sources) and download the observation chart PDF from there.
- Official: RCP NEWS2 charts and report
- Your workplace: many NHS organisations use their own adapted layout. Use the version approved by your Trust.
- Medax note: Medax does not host a copy of the chart. This page is an explanation, and any Medax practice material is labelled “Medax Educational Practice Resource. This is an educational resource and is not an official NHS, NMC or Royal College of Physicians document.”
Completed NEWS2 Chart Example
Educational example: fictional patient data. Not a real patient and not an official chart.
A fictional adult patient on a medical ward, with a suspected chest infection, breathing room air:
| Parameter | Reading | Score |
|---|---|---|
| Respiration rate | 22 breaths/min | 2 |
| SpO₂ (Scale 1) | 95% | 1 |
| Air or oxygen | Air | 0 |
| Systolic BP | 108 mmHg | 1 |
| Pulse | 96 bpm | 1 |
| Consciousness | Alert | 0 |
| Temperature | 38.2 °C | 1 |
| Total | 6 |
Walking through it:
- Score each parameter using the chart, without rounding or estimating.
- Add the six scores. There is no oxygen uplift because the patient is on air.
- The total is 6, which is in the 5–6 band, described by the RCP as a key threshold for urgent response.
- No single parameter scores 3, so there is no red score, but the aggregate alone triggers review.
- The patient has a suspected infection and a score of 5 or more, so sepsis should be considered.
- Next steps follow local policy: escalate to the appropriate clinician urgently, increase monitoring to at least hourly until review, and document the score, time, action taken and who was informed.
NEWS2 Chart and NMC OSCE Preparation
Here is what can be said accurately. The NMC publishes mock OSCE materials for its Test of Competence. In the Adult Nursing and Nursing Associate mock OSCEs, the assessment station provides a NEWS2 chart and the marking criteria include recording vital signs accurately and calculating the score accurately. The Children’s Nursing mock OSCE uses a Paediatric Early Warning Score (PEWS) instead, which is consistent with NEWS2 being an adult tool. I did not verify NEWS2 use in the Mental Health or Midwifery materials.
What this does not mean: NEWS2 is not a stand-alone OSCE station. It appears as a documentation and assessment task inside a wider station. Always check the current NMC candidate materials, because they change.
How NEWS2 knowledge supports OSCE-style work:
- Observations: measuring accurately and recording them correctly.
- Recognising deterioration: linking a score to the patient’s overall picture.
- Documentation: dating, timing, initialling and completing the chart neatly. Errors in calculation or documentation matter in exam marking as they do in practice.
- Communication: explaining what you are doing to the patient and reporting findings clearly.
- Escalation: knowing that a score triggers action and following the escalation route you would use in a UK setting.
Practise scoring blank charts under timed conditions and read the official NMC mock OSCE for your field. If you want structured practice with feedback, see Medax’s NMC OSCE preparation and OSCE training options, including Adult Nursing OSCE Comprehensive.
Common NEWS2 Chart Mistakes
- Incomplete observations. Missing a parameter (often respiratory rate) gives a falsely low total.
- Mis-scoring near thresholds. For example, reading 94% as 0 rather than 1 on Scale 1.
- Forgetting the oxygen uplift. Patients on supplemental oxygen get +2.
- Choosing Scale 2 without authority. It needs a clinical decision and a note in the records.
- Not crossing out the unused SpO₂ scale. The RCP says to do this.
- Treating confusion as normal. New confusion scores 3, and unclear cases are treated as new.
- Relying on the number alone. Concern overrides the score, and some patient groups are outside NEWS2 or need caution.
- Not recording the response. The chart should show what was done after a trigger.
- Using outdated versions. Use the version your Trust approves and check it against the RCP.
NEWS2 Chart FAQs
What is a NEWS2 chart?
An NHS-standard observation chart for recording vital signs and calculating the National Early Warning Score in adults.
What is NEWS2 used for?
To assess acute illness severity, detect deterioration and trigger a timely, competent clinical response.
What does NEWS2 mean?
National Early Warning Score 2, the updated RCP version from 2017.
What is NEWS2 Scale 2?
An oxygen saturation scale for patients with confirmed hypercapnic respiratory failure and a target of 88–92%, chosen by a competent clinician and documented.
How often should NEWS2 observations be monitored?
The RCP recommends minimums by score, from 12-hourly at 0 to continuous at 7 or more, but clinicians and local policy may change this.
What does NEWS2 escalation mean?
Passing the patient to a clinician or team with the right skills, at a speed matched to the score, following local procedure.
Who is NEWS2 used for?
Adults aged 16 and over. Not recommended in children or pregnancy.
Where can I find a NEWS2 chart PDF?
On the RCP’s NEWS2 page. Your Trust may also provide its own approved version.
Can I print a NEWS2 chart?
The RCP allows use of the charts with acknowledgment, in colour and unmodified. Use the official file.
Is NEWS2 relevant to NMC OSCE preparation?
Yes. NMC mock OSCE materials for adult nursing and nursing associates include a NEWS2 chart, so scoring accurately is worth practising. Check the latest NMC materials for your field.
Disclaimer: This page is educational and general. It is not clinical advice for any individual patient. Follow your organisation’s policy and seek senior support when unsure.
Sources: see the external sources list on this page. (Publish the list from section 8.)
Ready to practise? Explore Medax’s NMC OSCE preparation or [talk to the team on WhatsApp]([PLACEHOLDER WhatsApp URL]).
