RM.

Nama :
EARLY WARNING OBSERVATION SCORE CHART
Tgl.Lahir : L/P
OBSTETRICS
No RM :
Tgl : Jam Ruangan :
:
Skor 0 1 2 3
Sp O2 (%) >95 90-94 88-89 <88
Urine Output (ml/jam) <50ml/2jam <100ml/4jam <10ml/jam
Kesadaran Alert Voice Confused/Agitated Unconsious/Pain :PU
Tanpa kateter 8 jam tanpa produksi urin & kandung kemih kosong 10 jam tanpa produksi urin
Tanggal
Waktu
39,5 3
39 3

38,5 3
1
38
37,5
37
36
1
35
3
Sub Score
3
210
3
200
2
190
2
180
2
170
2
160
2
150
1
140
130
120
110
100
90
1
80
3
70
3
60
3
50
3
40
3
30
3
Sistolik Sub Score
130 3

120 2
2
110
1
105
100
90
80
75
1
70
1
60
2
50
2
40
3
Sub score
3
35
3
30
2
25
1
20
15
1
10
2
5
3
Sub score
Urine Score
CNS score
SpO2 (%)

Total EWOSCO
Adopted from EWS Royal College of Physicians , United Kingdom, Modified by Maternal Fetal Medicine Division of Obstetrics and Gynecology Department of Medical Faculty UdayanaUniversity/Sanglah Hospital
TOTAL EWOSCO: EWOSCO 3= resiko deteriorasi kecil, EWOSCO 4-5=Kriteria deteriorasi sedang, EWOSCO ≥6= Kriteria deteriorasi Berat