Vital Signs Date EWS Date
Time (24 ho ur) Time (24 ho ur)
Respiratory Rate
(breaths/min)
write RR value in box
≥ 36 ≥ 36
25-35 325-35
21-24 221-24
12-20 012-2 0
9-1 1 19-11
5-8 35-8
≤ 4 ≤ 4
Oxygen
(L/mi n)
Room air 0 Room air
Supplement (L/min) 2Supplement (L/min)
Oxygen
Saturation (%)
write SpO2 value in
box
≥ 96 0≥ 9 6
94-95 194-95
92-93 292-93
≤ 91 3≤ 91
Heart Rate
(bpm)
mark HR with X
write value if off scale
Write if ≥ 140 Write i f ≥ 140
130s 3130s
120s 2120s
110s 110s
100s 1100 s
90s 90s
80s
0
80s
70s 70s
60s 60s
50s 50s
40s 240s
30s 30s
Blood Pressure
(mmHg )
score systolic BP
value only
Write if ≥ 220 3Write if ≥ 220
210s
0
210s
200s 200s
190s 190s
180s 180s
170s 170 s
160s 160 s
150s 150s
140s 14 0s
130s 130s
120s 120s
110s 110s
100s 1100 s
90s 290s
80s 380s
70s 70s
60s 60s
50s 50s
Temperature
(oC)
mark Temp with X
write value if off scale
≥ 39s 2≥ 39s
38s 138s
37s 037s
36s 36s
35s 135s
≤ 34s 2≤ 34s
Level Of
Consciousness
mark LOC with
Alert 0Alert
Voice 3Voice
Pain Pain
Unresponsive Unresponsive
EARLY WARNING SCORE TOTAL EW S TO TAL
ESCALATE CARE FOR ANY PATIENT YOU, THEY OR THEIR FAMILY ARE
WORRIED ABOUT, REGARDLESS OF VITAL SIGNS OR EWS
Mandatory escalation pathway
Total Early Warning Score (EWS) Action
EWS 1-5
EWS 6-7
Acute illness or unstable
chronic disease
EWS 8-9
or any vital sign in red zone
Likely to deteriorate rapidly
EWS 10+
or any vital sign in blue zone
Immediately life
threatening critical illness
Modification to Early Warning Score (EWS) Triggers
The EWS can be changed to prevent chronic disease incorrectly triggering escalation.
All modifications must be made in line with hospital policy and
regularly reviewed by the primary team.
Ignore any modification that is not signed and dated.
Vital sign
(use abbreviation)
Accepted values and
modified EWS
Date and
time
Duration
(hours)
Name and contact
details
/ /
:
Reason:
/ /
:
Reason:
/ /
:
Reason:
/ /
:
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:
Given Name: Gender:
AFFIX PATIENT LABEL HERE
Date of Birth: NHI#:
Family Name:
Given Name: Gender:
AFFIX PATIENT LABEL HERE
Date of Birth: NHI#:
Adult Vital Signs Chart side 1
RRT
RRT
RRT
RRT
RRT
RRT
144 characters max
240 characters max
96 characters max
96 characters max
274 characters max
Insert organisational logo
or identifier here
Organisational document identifier
NOT FOR CPR
NOT FOR RRT
