• Meli Diana Medical-Surgical Nursing Department, Health Polytechnic of Kerta Cendekia, Sidoarjo
  • Dimas Hadi Prayoga Medical-Surgical Nursing Department, Health Polytechnic of Kerta Cendekia, Sidoarjo
  • Dini Prastyo Wijayanti Emergency Nursing Department, Health Polytechnic of Kerta Cendekia, Sidoarjo
Keywords: Early warning system, nurse care, literature review


Hospital service is a process that involves all elements in the hospital including nurses and inpatient rooms or nursing wards. Different inpatient conditions will be treated in separated wards, by the same token patients with unstable conditions are admitted in intensive care units, this procedure aims to reduce the mortality incidence due to sudden cardiac arrest, therefore early detection of patients clinical deterioration using the early warning score system performed by the nurse in the nursing wards is required. This review aims to describe the importance of the early warning system in the nursing wards. The data was obtained from international journal providers s from data base search based on Scopus, Ebscohot: CINHL, Proquest, Springerlink, Google scholar, and Midline. We used the keyword "Early Warning System" or "Early Warning Score" with a search range in 2016-2021. The search results in 127 articles. Language selection was performed as all journals found were in English. Here, we will review 10 articles. Implementation of early warning score in nursing ward is expected to improve the quality of service to patients and reduce the mortality rate. Early detection clinical emergency or known as the Early Warning Score System (EWSS) is the application of a scoring system for early detection of patient's condition before a worsening situation occurs. The implementation of this scoring system is necessary due to the high rate of deterioration of patient conditions that requiring immediate management to prevent profound deterioration and its subsequent adverse effect.


Christofidis et al. (2015). Early-warning scoring systems affects the speed and accuracy of scoring. DOI: 10.1111/jan.12618

Dean, E. (2018). National Early Warning Score Update. Nursing Older People, 30(2): 12. doi: 10.7748/nm.25.1.14.s9

Desy, K. (2017). Gambaran Pelaksanaan Clinical Response Early Score (NEWS) oleh Perawat di Rumah Sakit Siloam Bali. University Pelita Harapan Karawaci.

Duncan, K.,& McMullan, C. (2012) Early Warning Systems: The Next Level of Rapid response. doi: 10.1097/01.NURSE.0000410304.26165.33.

Fox, A.,Elliott, S. (2015) Early Warning Scores: A Sign Of Deterioration In Patients And Systems. doi: 10.7748/nm.22.1.26.e1337.

Hutabrat, Veronica., Novitasari, Enie., Satinah. (2020). Modifikasi Asesmen Early Warning System Upaya Peningkatan Penerapan Keselamatan Pasien.

Jensen et,al. (2017). A Multicentre, Randomised Intervention Study Of The Paediatric Early Warning Score: Study Protocol For A Randomised Controlled Trial Claus Sixtus. doi: 10.1186/s13063-017-2011-7

Kemenkes RI. (2017). Sistem Informasi Kesehatan II Statistik Pelayanan Kesehatan

Kyriacos U., Jelsma J., James M., Jordan S. (2014). Monitoring vital signs: development of a modified early warning scoring (MEWS) system for general wards in a developing country. DOI: 10.1371/journal.pone.0087073

Nur, Qalbi., Nursalam., Ahsan. (2020). Knowledge and Skill in Relation to the Speed and Accuracy of the Nurses When Assessing Using an Early Warning System (EWS).

Nusdin. Handayani, T. (2018). The Effect of Nursing Early Warning Score System (Newss) Based Application on Reducing Frequency of Emergency Cardiac Arrest: A Case Study of Pelamonia Hospital, Makassar.

Odell, M., Rechner, I., Kapila, A., et al. (2007). The effect of a critical care outreach service and an early warning scoring system on respiratory rate recording on the general wards. DOI: 10.1016/j.resuscitation.2007.01.035

Pagala., & Shaluhiyah. (2017). Perilaku Kepatuhan Perawat Melaksanakan SOP Terhadap Kejadian Keselamatan Pasien di Rumah Sakit X Kendari.

Subhan, Nurul., Giwangkencana, Gezy W., Prihartono, M.A., Tavianto, Doddy. (2017). Implementasi Early Warning Score pada Kejadian Henti Jantung di Ruang Perawatan Rumah Sakit Dr. Hasan Sadikin Bandung yang Ditangani Tim Code Blue Selama Tahun 2017.

Suwaryo, Putra Agina., Sutopo, Rahmad., Utoyo Bambang. (2019). Pengetahuan Perawat dalam Menerapkan Early Warning Score System (EWSS) di Ruang Perawatan.

Smith, B. (2015) Early warning scores: unravelling detection and escalation. doi: 10.1108/IJHCQA-07-2015-0086.

Stafesth, S. Gronbeck S (2016). The experiences of nurses implementing the Modified Early Warning Score and a 24-hour on-call Mobile Intensive Care Nurse: An exploratory study. DOI: 10.1016/j.iccn.2015.07.008

Wood C, Chaboyer W, Carr P, (2019) How do nurses use early warning scoring systems to detect and act on patient deterioration to ensure patient safety? A scoping review. 94:166-178. doi: 10.1016/j.ijnurstu.2019.03.012.

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How to Cite
Diana, M., Prayoga, D. H., & Wijayanti, D. P. (2021). IMPLEMENTATION OF EARLY WARNING SYSTEM IN NURSING WARD: A LITERATURE REVIEW. Nurse and Health: Jurnal Keperawatan, 10(1), 126-134.
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