Irish National Early Warning System (INEWS)

What's new in INEWS V2

  •  Increased emphasis on clinical judgment and using the INEWS track and trigger tool as an aid to assist clinical judgment and decision-making rather than as a standalone tool.
  •  The addition of ‘healthcare worker/patient/family concern’ on the INEWS patient observation chart to capture, acknowledge and act on early concern.
  •  New ‘cues for caution’ included on the INEWS Escalation and Response Protocol to remind staff to think about the potential for patient deterioration.
  •  An increased emphasis on changes in respiratory rate as a key early indicator of deterioration.
  •  ‘New confusion’ – an early sign of deterioration – is captured as ‘C’ in ACVPU.
  •  The requirement for a minimum of 6 hourly observations for the first 24 hours following admission.
  •  A new recommendation stating that the adjustment of INEWS parameters or a patient’s INEWS score is NOT permitted.
  •  The option for a Consultant or Registrar to use a Modified INEWS Escalation and Response Protocol for patient’s whose baselines fall outside of INEWS parameter ranges.
  •  The facility for a Registered General Nurse to defer escalation for a brief period of time (max. 30 minutes).
  •  A three-tiered response model (bedside, urgent and emergency) evolving to an Advanced Nurse Practitioner response service.
  •  Closed-loop governance to drive improvement at clinical and organizational levels.

National Clinical Guidelines -

INEWS Patient Observation Chart

The national INEWS patient observation chart was redesigned to correspond with the revised clinical guideline. Human factors expertise was sought to ensure optimal chart design as were the views and experiences of frontline staff.  Two sections were added to the back of the chart – one for Consultant or Registrar documentation of a Modified Escalation and Response Protocol and the second for the documentation by an RGN of the decision to defer escalation. 

The Glasgow Coma Scale (GCS) is now included in the three-fold version of the chart.  The chart is also available as a two-fold design without the GCS.  

INEWS Patient Observation Chart (PDF, 784 KB, 2 pages)

How to use the Patient Observation Chart (PDF, 521 KB, 2 pages)

INEWS Education Resource

The INEWS V2 education programme aims to support clinical staff in the acute settings to use the Irish National Early Warning System to anticipate, recognise, escalate, respond and evaluate a non-pregnant patient (≥16 years) effectively in line with the INEWS V2 National Clinical Guideline.

INEWS V2 education resources:

1-hour INEWS e-learning programme -

INEWS V2 Facilitators slide deck (PDF, 5.21 MB, 88 pages)

Irish National Early Warning System incorporating COMPASS (PDF, 1.18 MB, 89 pages)

Healthcare Assistants Education Sessions

ISBAR Communication Tool (PDF, 297KB, 1 page)