2. Modified Early Warning System
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.
• 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
Spring Hill Data 2016 DATA:
• RRT = 115
• Code Blue = 58
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
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
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
• Go live date April 11th
• Units participating are Telemetry and 2N