Multiparameter Early Warning Score (MEWS) in the Electronic Health Record

Purpose:
Earlier identification of deterioration of the medical surgical adult patient.

Significance:
Our health system has mature Cardiac Resuscitation and Rapid Response teams. We have found in analysis of most of the rapid responses on 2010 a decline in the patients physiologic parameters 4-12 hours prior to the call of the rapid response team.

Strategy and Implementation:
We implemented within our Electronic Health Record an automated calculation of the MEWS score, and we implemented a standard of practice of nursing and provider response to elevated MEWS scores. Our multidisciplinary team (providers, nurses, educators, Information Technology) developed the workflows, piloted the process on 4 units, and implemented the practice in November 2011 on all of our adult Med Surg units. We also implemented MEWS protocols in the Emergency Department, ICU's and the Perioperative suite. The protocols include increased surveilance when MEWS is elevated, provider evaluation when MEWS continues to elevate, and Rapid Response team notification when MEWS reaches a certain score. Our process metrics were evaluated using information technology, and not one chart review is needed. We took advantage of the data in the EHR for automated reporting.

Evaluation:
We evaluated how often the nurses increased their surveilance with elevated MEWS, and whether or not nurses applied MEWS standards of care when MEWS was elevated. November 2011 we were at 70% compliance, we are now at 90-95% compliance.

Implications for Practice:
We are about to measure our outcomes, which include: transfers to the ICU, Cardiac Arrests outside of the ICU, mortality outside of the ICU.