Upload
bcpsqc
View
515
Download
1
Tags:
Embed Size (px)
Citation preview
Improving patient safety and care quality using a Modified Early Warning Scoring System (MEWS) on an inpatient cardiac medicine unit
Holly Andrews RN; Jean Carne RN, MScN; Andrea Fong RN, BSN, CCN(C); Jenny Knoll, RN BSN; Christopher Talusan RN, BSN and Robert H Boone, MSc MD FRCPC
5A – Heart Centre St. Paul5A – Heart Centre St. Paul’’s Hospitals Hospital
• Referral center for British Columbia’s most acute cardiac patients.
• Cares for many complex cardiac patients who have an increased risk of experiencing adverse events.
• Prior to implementing the MEWS system our cardiac medicine unit (5A) had one of the highest numbers of code blue responses in the hospital (excluding Critical Care).
5A Code Data – Before MEWS5A Code Data – Before MEWS
Data provided by SPH Code team
• A simple tool to help nurses detect early deterioration of patients.
• Subtle changes may be apparent up to 8 -12 hours prior to an adverse event.
• A score is generated based on 5 physiological parameters:
– blood pressure (BP)
– heart rate (HR)
– respiratory rate (RR)
– temperature (T)
– level of consciousness (LOC)
The specific goals of implementing MEWS were:
1. Patient Safety
2. More efficient transfer of unstable patients to critical care
3. More timely physician interventions
4. Decreased number of code blues
5. Improved communication between nurses and physicians
• Registered Nurses
– One from each rotation
• Clinical Nurse Leader
• Clinical Educator
• Physician
• Operational Leader
• Institute for Health Care Improvement sponsored 6 webinar series
– a total of 274 people attended from international centres
• 2+ month period
• Tests of changes included:
– Code blue chart audits
– Determining tool’s ease of use
– Development of tool to meet our patient population
– Tool validation
– Confirming tool accuracy of patient condition
– Algorithm development for use with tool
• Nurse found the tool easy to use and reliable to trend patients condition.
Modifier: For non surgical pain please add the following to your MEWS score:
Green = 0 – 1 Yellow = 2 – 3 Orange = 4 – 5 Red = ≥ 6
Modified Early Warning System (MEWS) - 5A 3 2 1 0 1 2 3
Resp rate per minute
Less than 8 9-17 18-20 21-29 More than 30
Heart rate per minute
Less than 40 40-50 51-100 101-110 111-129 More than 130
Systolic blood pressure
Less than 70 71-80 81-100 101-159 160-199 200-220 More than 220
Conscious Level (AVPU)
Unresponsive Responds to pain
Responds to voice
Alert Agitation or confusion
New onset of agitation or confusion
Temperature Less than 35.0 35.1-36 36.1-38 38.1-38.5 More than 38.6
Ongoing pain unrelieved with intervention ADD 3 points
Pain relieved with intervention but pain returns within 2 – 4 hours ADD 2 points
Pain relieved with intervention but pain returns within 8 hours ADD 1 point
Color Action
0-1 Green Rescore with VS as per protocol
2-3 Yellow Ensure accuracy and significance of findings
Investigate cause and treat appropriately
Notify Charge Nurse
RN reassesses and rescores in 4 - 6 hrs (use clinical judgment)
Notify MRP if patient scores 3 in any one single category4-5 Orange Ensure accuracy and significance of findings
Investigate cause and treat appropriately
Notify MRP
Notify Charge Nurse
Page Clinical Resource Nurse
RN monitors and rescores q1hr until improvement in patient’s condition
-if no improvement after 2 hrs, notify MRP for reassessment and plan
-5A CN to notify Critical Care CN of patients condit ion
When stable reassess and rescore depending on most recent score6+ Red Ensure accuracy and significance of findings
Investigate cause and treat appropriately
Notify MRP
Notify Charge Nurse – CN to notify Critical Care CN of patients condition
Page Clinical Resource Nurse
RN monitors and rescores q15 minutes until improvement in patient ’s condit ion
-if no improvement after 1 hrs, notify MRP for reassessment and plan
Key Features:
– Clear expectations
– Physician response times
– Communication plan
• 1:1 teaching sessions to each RN
• Daily follow-up and support
• Medical orientation and support
• Completed with each set of VS
• Recorded on daily charting record
• Elevated MEWS score: Orange / Red are added to patient care board
Arrests Arrests
Data provided by SPH Code team
Codes Codes
Data provided by SPH Code team
RED MEWS
Orange MEWSOrange MEWS
• Mews works for our patient population
• No adverse impact on RN workload
• No adverse impact on Physician workload
• More efficient transfer of unstable patients to critical care
• More timely physician interventions
• Improved communication
• Nursing and Physician
• Charge Nurse to Charge Nurse
Thank youThank you
Contact us:
Articles– Morgan, RJM, et al. An Early Warning Scoring System for
detecting developing critical illness. Clin Intens Care 1997; 8:100
– Stenhouse C, Coates S, Tivey M, Allsop P, Parker T. Prospective evaluation of a modified Early Warning Score to aid earlier detection of patients developing critical illness on a general surgical ward [Abstract] Br J Anaesth. 1999;84:663P