The part reviews the available literature concerning the importance of MEWS and its implementation. It considers the factors within the healthcare that may hinder its proper functioning when implemented.
Mathukia et al. (2015) attempted to investigate how the recognition of clinical changes along with appropriate early interventions can help in preventing adverse outcomes among them being cardiac arrest and death. They implemented MEWS in an Academic Community Hospital in Easton that had no ICU wards. Upon the implementation of MEWS, the number of RRTs increased, while the rate of Code Blues decreased and an associated decline in overall mortality. Mathukia et al. (2015) recommended that a widespread use of MEWS would improve patient outcomes.
Cherry & Jones (2015, 09) investigated the attitudes of nursing staff towards a MEWS. They also ascertained the possible problems associated with the application of MEWS and the measures adopted by the nursing staff to identify and to explore possible improvements that would assist to improve the care of the high scoring patients. It was a qualitative study that applied mixed methods. It was set in an acute medical unit in with nursing staff. The findings indicated that MEWS chart was outstanding at alerting the nursing and other medical staff about the patients with deteriorating conditions, meaning that the attitudes of the nurses are instrumental to a successful implementation of MEWS in HER. They recommended that when used correctly, MEWS would assist in alerting the nursing staff and guiding the medical staff to take the most appropriate action for the patient (Cherry & Jones (2015, 09).
Quarterman et al. (2005, 04) focused on auditing the clinical information system to facilitate the implementation of MEWS system in both the medical and surgical wards. They also investigated the association amid the patient outcomes, trigger score age and medical specialty. The study was qualitative with retrospective data collection and involved 885 patients. The findings suggested that consistent response to the ward staff from the patients with MEWS improved compliance with the process. They recommended MEWS for improving patient outcomes and the use of the patient information systems to audit systems to assist in the implementation of MEWS. Quarterman et al. (2005) identify the significance of using the MEWS scores in patient’s medical records for nursing and medical staff to review.
Mullany et al. (2016) noted that the unrecognized deterioration of patients in hospital wards leads to adverse outcomes for the patient among them being cardiac arrest, unplanned admission to ICU or even death. The underuse of the escalation process and the current calling criteria that are operational is infective leading to patient’s clinical deterioration. They, therefore, conducted a study at the Prince Charles hospital among the hospitalized patients to determine the effect of the introduction of a rapid response system on process and outcome measures. The findings suggested that a low MET dose connected with enhanced hospital mortality when joined with a MEWS together with a means of improving communication (Mullany et al. (2016). They recommended the use of MEWS along with a properly designed escalation system to improve results with a low MET activation rate to minimise the consumption of resources allocated for the MET providing unit.
Kyriacos et al. (2014, 01) conducted a qualitative study to establish and authenticate a construct and content of an observation chart for nurses integrating a MEWS system for physiological aspects for monitoring the patients from their bedside monitoring on wards in a public hospital. They used a multidisciplinary approach when developing the MEWS System among the general medical ward patients. The findings indicated that experience among the clinicians, education, the nurse-patient ratios and the hospital setting play a critical role in adverse events. They recommended seven physiological parameters with their respective colour-branded cut points (thresholds) and weighted points (Kyriacos et al. 2014, 01).
Page, Blaber & Snowden (2008) believed that MEWS could be essential in alleviating the particular needs of the acute hospital and further would lead to positive outcomes for the patients in the general wards. They piloted a nursing tool consisting of a colour-coded observation chart and response algorithm to back the nurses in the critical ill wards. They aided in identifying in advance the conditions of the patient and alerting rapid response concerning the deteriorating patients. It was conducted in two general wards, one 30 beds and the other 41 in an Australian private hospital. The findings showed that MEWS is a valuable tool in enhancing the work of ward nurses in the care of patients with critical illness and the system would be stretched to other wards (Page, Blaber & Snowden, 2008). They recommended adapting MEWS to all the Australian hospitals to provide the ideal care for patients with critical illnesses.
In conclusion, the literature regarding the use of a Modified Early Warning Scoring (MEWS) to decrease the risk of deterioration in patients on a general ward during hospitalization is diverse. It lays a good foundation for this project for incorporating MEWS in HER. It illustrates the significance of MEWS in delivering quality healthcare.
We can do it today.
- Cherry, P. G., & Jones, C. P. (2015, 09). Attitudes of nursing staff towards a Modified Early Warning System. British Journal of Nursing, 24(16), 812-818. doi:10.12968/bjon.2015.24.16.812
- Kyriacos, U., Jelsma, J., James, M., & Jordan, S. (2014, 01). Monitoring Vital Signs: Development of a Modified Early Warning Scoring (Mews) System for General Wards in a Developing Country. PLoS ONE, 9(1). doi:10.1371/journal.pone.0087073
- Mathukia, C., Fan, W., Vadyak, K., Biege, C., & Krishnamurthy, M. (2015, 01). Modified Early Warning System improves patient safety and clinical outcomes in an academic community hospital. Journal of Community Hospital Internal Medicine Perspectives, 5(2), 26716. doi:10.3402/jchimp.v5.26716
- Mullany, D. V., Ziegenfuss, M., Goleby, M. A., & Ward, H. E. (2016). Improved hospital mortality with a low MET dose: the importance of a modified early warning score and communication tool. Anaesthesia and intensive care, 44(6), 734-741.
- Page, M., Blaber, I., Snowden, P. (2008). Implementing a modified early warning system for critically ill patients in an acute private hospital. CONNECT: The World of Critical Care, 6(3), 57-64.
- Quarterman, C. P., Thomas, A. N., Mckenna, M., & Mcnamee, R. (2005, 04). Use of a patient information system to audit the introduction of modified early warning scoring. Journal of Evaluation in Clinical Practice, 11(2), 133-138. doi:10.1111/j.1365-2753.2005.00513.x