Annual Nursing Research & Evidenced Based Practice Symposium

Decreasing Preventable CodesSeptember 10, 2009

By

Minnie Gaffney RN, CCRN

The Rapid Response Team and MEWS

The Rapid Response Team and MEWSBackground

• Initiated at NMH, January 2006

• Nurse lead, dedicated team

• Proactive

• Wanted to impact patient care

Choices

• APACHE II– ER/ICU population

– Lengthy

– Not all information available for general population

– Labor intensive for primary floor nurses

• MEWS – Easy short form for hand

calculations

– All information easily available

– Readily accepted by RNs and PCTs who assisted with trial

Modified Early Warning Score

3 2 1 0 1 2 3

Systolic Blood pressure (mmHg)

<70 71-80 81-100 101-199 ≥200

Heart Rate (bpm)

<40 41-50 51-100 101-110 111-129 ≥130

Respiratory rate (bpm)

<9 9-14 15-20 21-29 ≥30

Temperature (°C)

<35 35-38.4 ≥38.5

AVPU score Alert Reacting to

Voice

Reacting to

Pain

Unresponsive

MEWS (Modified Early Warning Score)

3 2 1 0 1 2 3 Total

Temp <36°C

<96.8°F

36-38°C

96.8-100.4°F

>38°

>100.4°

HR (bpm) <41 41-50 51-100 101-110 111-129 >129

RR (bpm) <10 10-20 21-24 25-28 >28

SpO2 <91% 91-94% 95-100%

SBP (mmHg) <81 81-90 91-100 101-160 161-170 171-180 >180

CAM + -

Resp Assessment + -

Rapid Response Team goes ElectronicAn electronic MEWS scoring patients based on vital sign data entered into PowerChart, was developed to assist RRT RNs in their proactive identification of at-risk patients.

Rapid Response Team: Results

Preventable Codes Per Patient Days(Lower is better)

0

0.2

0.4

0.6

0.8

1

1.2

FY06Q3

FY06Q4

FY07Q1

FY07Q2

FY07Q3

FY07Q4

FY08Q1

FY08Q2

FY08Q3

FY08Q4

FY09Q1

FY09Q2

Preventable Codes/Pt DaysFY08Linear (Preventable Codes/Pt Days)

RRT Calls / Patients Seen

0

50

100

150

200

250

300

350

400

450

500

Jan

08

Feb

08

Mar

08

Apr

il 0

8

May

08

June

08

July

08

Aug

08

Sept

08

Oct

08

Nov

08

Dec

08

Staff Activated MEWS Activations Other

An observed reduction in average number of preventable codes per 1000 patient days has been achieved since the implementation of the electronic MEWS; and on average an additional 250 patients are seen by the RRT RN each month. To date 15,870 patients have been seen by RRT.

Rapid Response Team: Results

Preventable Codes Per Patient Days(Lower is better)

0

0.2

0.4

0.6

0.8

1

1.2

Preventable Codes/Pt DaysFY08Linear (Preventable Codes/Pt Days)

An observed reduction in average number of preventable codes per 1000 patient days has been achieved since the implementation of the electronic MEWS; and on average an additional 250 patients are seen by the RRT RN each month. To date 15,870 patients have been seen by RRT.

Thank You!

• Pat Murphy, RN, MSN, MBA

• Kristin Ramsey RN, MSN, MPPM, NE-BC

• All of my Rapid Response Team colleagues, awesome nurses!