Quality Improvement In Healthcare Modified Early Warning System

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Quality Improvement In Healthcare: Modified Early Warning System (MEWS) Tracy Cornille, Joanna Gallano, Renee

Quality Improvement In Healthcare: Modified Early Warning System (MEWS) Tracy Cornille, Joanna Gallano, Renee Schafer, Valerie Snapp, & Chester Wheeler

Objectives £What is Quality Improvement in Healthcare £How MEWS Works £Goals of MEWS £Scoring

Objectives £What is Quality Improvement in Healthcare £How MEWS Works £Goals of MEWS £Scoring and Relevant Interventions £Efficacy of Pilot Studies £MEWS Scenarios

Quality Improvement £Quality Improvement- is the goal for making refinements in practice that are

Quality Improvement £Quality Improvement- is the goal for making refinements in practice that are based on efficacy and efficiency (Kearney. Nunnery, 2012, p. 10) £ Increase Efficiency £ Reduce Healthcare related Costs and Waste of Time/Resources £ Increase Patient Safety £ Increase Positive Patient Outcomes £ Increase Nurse’s Time at bedside £How can healthcare practices become more safer and efficient for both clinician and patient alike?

MEWS £Modified Early Warning System £ Scoring system based upon vital sign parameters £

MEWS £Modified Early Warning System £ Scoring system based upon vital sign parameters £ Level of Consciousness or Change in Mental Status, Temperature, Respirations, Systolic Blood Pressure, and (depending on facility) Oxygen Saturation and Urine Output £Each parameter is given a score £ Normal parameters = 0 £ Abnormal parameters = 1, 2, or 3 £Modifiable to each particular £ PACU = PEWS £ Obstetrics = MEOWS unit.

Goals of MEWS £ Increase Patient Safety £Identify l Physiological decline usually precedes critical

Goals of MEWS £ Increase Patient Safety £Identify l Physiological decline usually precedes critical illness onset (Steen, 2010) £Detect l high risk patients deteriorating patients earlier and call Rapid Response Trained team of specialists with advanced life saving training that can implement clinical judgment and care. £Prevent Code Blues and mortalities

Goals of MEWS £REDUCE COST £Peninsular Regional Medical Center MEWS Trial Unit 5 E

Goals of MEWS £REDUCE COST £Peninsular Regional Medical Center MEWS Trial Unit 5 E (Snyder, and Morcom, 2013) l Prior to MEWs on average of 2 codes per month = 24 yearly at an estimated cost of $3, 330 per code. After MEWS implementation, there were only 2 codes in 6 months resulting in mortalities at an estimated cost of $6, 660 Of the 24: 20% code blue mortality rate = 5 patients x 3, 330 = $16, 650 l 80% survival rate= 19 patients x $20, 684 = $392, 996 l

MEWS SCORING PARAMETERS 3 2 1 0 1 2 Temp <35. 1 -36 36.

MEWS SCORING PARAMETERS 3 2 1 0 1 2 Temp <35. 1 -36 36. 1 -38 38. 1 -38. 5 >38. 5 Resp Rate <9 9 -14 15 -20 21 -29 >/=30 Heart Rate <40 40 -50 51 -100 101 -110 111 -129 >130 81 -100 101 -199 Systolic BP <71 71 -80 LOC Unrespon sive Responds Alert to Pain to voice >/=200 New Agitation/ confusion 3

SCORING & INTERVENTIONS £Once the vitals are entered by the RN or Tech, computer

SCORING & INTERVENTIONS £Once the vitals are entered by the RN or Tech, computer software will alert the RN to the patient's total score. Some facilities use a color coded system to emphasize degree of concern or risk 0 -2 GREEN 3 YELLOW 4 ORANGE 5 RED £PRMC MEWS system notifies a comprehensive team of MEWS specialists to verify score and ensure interventions are carried out appropriately. (Snyder, and Morcom, 2013. )

MEWS Effects on Nursing £MEWS enables nurses to know when to: £continue monitoring and

MEWS Effects on Nursing £MEWS enables nurses to know when to: £continue monitoring and perform routine care £increase monitoring of VS and when to inform others of changes in VS £When to notify the physician(s) £When to contact the RR team for help £Long term: Identify particular populations prone to triggering system: Sepsis, Resp Failure

MEWS ORIGINS: EWS £Derived from the Early Warning System implemented in Europe, MEWS is

MEWS ORIGINS: EWS £Derived from the Early Warning System implemented in Europe, MEWS is rather new in the United States. £Ysbyty Gland Clwyd (YBC), a 900 bed acute care hospital located in Central North Wales, as a part of the Institute for Healthcare Improvement's Safer Patients Initiative (SPI), has been using MEWS for many years now. £The SPI is actively working to improve the quality and safety of health care in the UK by encouraging the uptake and spread of best practices (Early Warning Systems: Scorecards That Save Lives, 2014, p. 2).

Pilot Studes £ 2008 Mercy Hospital Anderson, Cincinnati, Ohio 252 bed acute care hospital,

Pilot Studes £ 2008 Mercy Hospital Anderson, Cincinnati, Ohio 252 bed acute care hospital, 9 month pilot (Snyder, and Morcom, 2013) £ 50% decrease in Code Blues per 1000 patient days £ 110 % increase in Rapid Response per patient days £ 2012 Peninsula Regional Medical Center, Salisbury, Maryland, Unit 5 E, 42 bed Med/Surg, 9 month pilot (Snyder, and Morcom, 2013) £ 67% decrease in code blues per 1000 patient days £ 76% increase in Rapid Response per 1000 patient days

Implementing MEWS £ YGC provided laminated cards for all nursing staff as well as

Implementing MEWS £ YGC provided laminated cards for all nursing staff as well as monthly educational meetings on MEWS £ PRMC in Maryland: Staff Education (Nursing, £ Net learning £ Story Boards £ Articles in department publications £ Presentation to staff at department meetings £ Go-Live Support Ancillary and Physician): £ Education at Munroe Regional was done on a unit to unit basis after a successful pilot on Medical Surgical £ No official data available for Munroe Regional, but rapid response calls have increased significantly in the last few months since MEWS implementation.

SCENARIO 1 £You walk into the patient's room shortly after shift change. He is

SCENARIO 1 £You walk into the patient's room shortly after shift change. He is asleep and doesn't startle while you adjust the blood pressure cuff on his arm. You say good morning a few times until he finally opens his eyes and responds back a garbled " good morning" and closes his eyes again. £Vitals are as follows: T- 38 C RR- 20 HR-98 BP-150/85 £What is his MEWS and what are your interventions?

MEWS & INTERVENTIONS 2 T- 38 = 0 RR- 20=1 HR-98 =0 BP-150/85=0 Responds

MEWS & INTERVENTIONS 2 T- 38 = 0 RR- 20=1 HR-98 =0 BP-150/85=0 Responds to Voice = 1 Interventions: ? ?

SCENARIO 2 It's been two hours and you go back to reassess the patient

SCENARIO 2 It's been two hours and you go back to reassess the patient and get a new set of vitals. You find him restless in the bed, pulling at his wires and IV tubing. You get him to settle a bit and take a new set of vitals. Vitals are as follows : T - 38 C RR- 28 HR-100 BP-90/60 What is his MEWS and what are your interventions?

MEWS & INTERVENTIONS 4 T - 38 C = 0 RR- 28 = 2

MEWS & INTERVENTIONS 4 T - 38 C = 0 RR- 28 = 2 HR-100 =0 BP-90/60 =1 New Agitation/Confusion = 1 Interventions: ? ?

SCENARIO 3 Patient is 2 days ago post right hemicolectomy HR 121, R 22,

SCENARIO 3 Patient is 2 days ago post right hemicolectomy HR 121, R 22, Temp 38. 7 C, Alert What is the MEWS scores and interventions?

MEWS & INTERVENTIONS 6 HR 121=2 R 22=2 Temp 38. 7 C= 2 Alert

MEWS & INTERVENTIONS 6 HR 121=2 R 22=2 Temp 38. 7 C= 2 Alert = 0 Interventions: ? ? ?

Literature Review of MEWS £Kyriacos, Jelsma, & Jordan (2011) Literature Review of MEWS Systems:

Literature Review of MEWS £Kyriacos, Jelsma, & Jordan (2011) Literature Review of MEWS Systems: Of 534 papers reporting MEWS/EWS systems for adult inpatients identified, 14 contained useable data on development and utility of MEWS/EWS “Better monitoring of patients implies better care, but searches indicate that the impact of vital signs monitoring and MEWS/EWS systems has yet to be tested in large, randomized controlled clinical trials. Nevertheless, there is sufficient evidence from observational work that MEWS/EWS systems facilitate recognition of abnormal physiological parameters in deteriorating patients, alerting ward staff to the need for intervention. ”

REFERENCES Carle, C. , Alexander, P. , Columb, M. , & Johal, J. (2013).

REFERENCES Carle, C. , Alexander, P. , Columb, M. , & Johal, J. (2013). Design and internal validation of an obstetric early warning score: secondary analysis of the Intensive Care National Audit and Research Centre Case Mix Programme database. Anaesthesia, 68(4), 354 -367. doi: 10. 1111/anae. 12180 Early Warning Systems: Scorecards That Save Lives (2014). Retrieved from http: //www. ihi. org/resources/Pages/Improvement. Stories/Early. Warning. Systems. Scorecards. Th at. Save. Lives. aspx Kearney-Nunnery, R. (2012). Advancing Your Careeer. Philadelphia, Pennsylvania: F. A. Davis Company. Kyriacos, U. U. , Jelsma, J. J. , & Jordan, S. S. (2011). Monitoring vital signs using early warning scoring systems: a review of the literature. Journal Of Nursing Management, 19(3), 311 -330. doi: 10. 1111/j. 1365 -2834. 2011. 01246. x Snyder, C. , & Morcom, J. (2013, January 1). Predicting Care Using Informatics. Retrieved October 5, 2014, from http: //www. mckesson. com/uploadedfiles/mckessoncom/content/about_mckesson/our_compa ny/businesses/mckesson_provider_technologies/awards/peninsula regional medical center 2013 daa final presentation. pdf