Modified early warning system 362017

Nursing tool used in a medsurg environment to detect early changes in patient conditions monitoring temperature, respirations level of consciousness and oxygen level

1. Modified Early Warning System (MEWS) Spring Hill

2. Modified Early Warning System (MEWS) Description: An evidenced-based organized screening tool with aggregated scoring of “multiple” pre-determined indicators to assist in early recognition and intervention of physiologic signs of patient deterioration. Temperature Heart rate Blood Pressure Respiratory rate Level of consciousness

3. Everything Starts with a Question and Data QUESTION: Can we detect and intervene to changes in patient conditions before they reach a deteriorated state requiring intervention from our Rapid Response and / or Code Teams? Spring Hill Data 2016 DATA: RRT = 115 Code Blue = 58

4. Why? To Eliminate Failures to Rescue Hospitalized patients often experience unrecognized physiological deterioration that can lead to critical illness, transfer to the ICU, cardiac arrest, even death. Research indicates that a patient’s condition generally deteriorates 6-8 hours prior to a code event. Schein et al. - 84% of patients had documented observations of clinical deterioration or new complaints within 8 hours of cardiopulmonary arrest with 70% experiencing either respiratory or mental function alterations.) Hodgetts et al. – 17% of cardiac arrests occurred on patients receiving care in an inappropriate area with 95% being avoidable versus 60% avoidable rate when the patient was at the right level of care. Early Recognition and Intervention = Decreased Morbidity and Mortality

5. RRT versus MEWS RRT intervention is typically triggered by one aspect of a patient's condition at a time. MEWS focuses on multiple areas

6. Scoring

7. Interventions

8. Patient Population Adult Medical-Surgical and Progressive Care Patients Ages 18 and greater Screening will be performed upon admission, twice per shift, and with changes in patient condition. Adult patients in Medical-Surgical and Progressive Care level of care will have routine Modified Early Warning System (MEWS) screening and interventions based on changes in temperature, heart rate, blood pressure, respiratory rate, and level of consciousness.

9. Benefits to Nursing It is a nursing decision tool. MEWS is an aid to good clinical judgment, not a substitute for critical thinking!

10. Clinical Scenario 46 Yr old F with Pneumonia On 2 liters NC oxygen Pulse ox 96% temp 99 HR occurs and patient is now 88% on Pulse ox and looks flushed Vital signs obtained Temp 101 Respirations 22 Heart Rate 111 What is MEWS score? Would you call a RRT?

11. Educational Plan Begin discussions with Nursing Directors and Quality Feb 2017 Query other CHS facilities for best practices Education to Directors March 7, 2017 Staff education roll out March - April staff meetings and Skills fairs Go live date April 11 th Units participating are Telemetry and 2N