mews - maternity early warning score - ko...
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Affix patient’s identification label here
MATERNITY EARLY WARNING SCORE
MIDWIFERY AND NURSING ACTIONSFOR PATIENTS WITH A MEWS SCORE
Score 0
Score 2
Score 1
ANY PATIENT VITAL SIGNS IN THE YELLOW SCORES 1
Calculate the Total MEWS Score1. Inform Midwife/Nurse in charge2. Increase frequency of vital signs one hourly or more frequently if required.3. Treat Pain
ANY PATIENT VITAL SIGNS IN THE PURPLE SCORES 5 OR MORE OR IF YOU ARE CONCERNED ABOUT THE PATIENT CALL
888
OBSTETRIC EMERGENCY TEAM or WOMENS HEALTH CARDIAC ARREST or STAT CAESAREAN SECTION Stay with the patient.
ANY PATIENT VITAL SIGNS IN THE ORANGE SCORES 2 - 4
Calculate the Total MEWS Score1. Inform Midwife/Nurse in charge2. Repeat vital signs within 1/2 hour.3. If MEWS score unchanged contact Obstetric Registrar, notify PAR Team.4. Continue 1/2 hourly vital signs until Obstetric Registrar arrives.5. If Obstetric Registrar not available call Obstetric Consultant.
Score 5+ 888
Score 0 0-499mls OBSERVE
Score 2 1000-1500mls
Score 1 500-1000mls
Score 5+ 1500mls+
VARIATION TO BLOOD LOSS THRESHOLDMeasuring Blood Loss estimate.Soaked Pad = 150mlsSoaked Blue inco sheet = 450mlsSoaked Towel = 600mls1ml blood = 1 gm weight
*Standard vital signs: q4H, Respiratory rate, Saturation, Heart rate, BP, Blood Loss,Temp, Level of consciousness, Urine output and Pain
PAD 150ml
INCO SHEET 450ml
TOWEL 600ml
Date
Time
Pain at Rest 0-10
Pain On Movement 0-10
Respiratory Rate
Saturations
Heart Rate
Systolic BP
Diastolic BP
Blood Loss
Temperature
Level of Consciousness
Urine Output
TOTAL SCORE
Respiratory Rate
Saturations
Heart Rate
Systolic BP
Diastolic BP
Blood Loss
Temperature
Conscious Level
Urine Output
TOTAL SCORE
Runn
ing
Tota
l Le
vel o
f Te
mpe
ratu
re
Runn
ing
Tota
l Di
asto
lic B
lood
Pre
ssur
e m
mHg
Sy
stol
ic B
lood
Pre
ssur
e m
mHg
He
art R
ate
bpm
Sa
tura
tions
Re
spira
tions
Urin
e Ou
tput
Co
nsci
ousn
ess
Bl
ood
Loss
(ml)
Glucose
O2 litres/min
Counties Manukau District Health Board
MEWS SCORE - Calculate total score. Add each vital sign to reach TOTAL MEWS SCORE
Reorder No. OBST56 July 14
Est bld loss on arrival
Copyright © CMHealth 2014. All Rights Reserved. No part of this document may be reproduced without CMHealth’s express consent.
>40 >40
30-39 30-39
25-29 25-29
20 20
15 15
10 10
<8 <8
98-100 98-100
94-98 94-98
91-93 91-93
<90 <90
>140 >140
130 130
120 120
110 110
100 100
90 90
80 80
70 70
60 60
50 50
40 40
30 30
>200 >200
190 189-199
180 180
170 170
160 160
150 150
140 140
130 130
120 120
110 110
100 100
90 90
80 80
70 70
60 60
50 50
140 140
130 130
120 120
110 110
100 100
90 90
80 80
70 70
60 60
50 50
1500+ 1500+
1000-1499 1000-1499
751-999 751-999
500-750 500-750
0-499 0-499
>38.5 >38.5
38.1-38.4 38.1-38.4
38 38
37 37
36 36
<35 <35
Alert Alert
Voice Voice
Pain Pain
Unresponsive Unresponsive
New Confusion New Confusion
>30ml/hr >30ml/hr
16-29 ml/hr 16-29 ml/hr
<15 ml/hr <15 ml/hr
Modified Parameters for
Childbirth
New Parameter
Running Total Blood Loss
Visual Aid for Blood Loss
Actions
Total Mews Score
Went LIVE 17 March 2014
MEWS - Maternity Early Warning Score Conny Krebs, Clinical Midwife Educator - Ko Awatea, Auckland, New Zealand
Gail McIver, Midwife Manager - CM Health, Auckland, New ZealandKathy Ogilvy, Nurse/Midwife Educator - Ko Awatea, Auckland, New Zealand
One woman too many Development Implementation
Major Haemorrhage After Birth Have Tripled
Multiprofessional Team
In 2010 the Women’s Health Quality Specialist Midwife brought together a multiprofessional team with the idea to develop a modified EWS for Maternity Services.
Midwives, nurses, managers, members of the Patient At Risk team, Clinical Training & Education Centre, Acute Pain team, obstetricians, anaesthetists and midwife and nurse educators formed a group and worked together over three years to develop and implement a modified early warning score for women during childbirth.
New ParameterA new parameter – blood loss – has been added to the MEWS score. Blood loss is one of the most common causes of preventable severe maternal morbidity, and is often exacerbated by delayed or inappropriate treatment. It can be one of the critical indicators of deterioration, and the amount of blood lost is frequently underestimated.
Modification for Birthing UnitsMEWS has also been introduced to the three primary birthing units. As these units operate in the community setting, have no medical staff onsite and rely on the ambulance service for transfer, the action plan has been modified to their needs. An easy peel-off sticker, with the action algorithm appropriate for the birthing units, is applied and makes it instantly functional.
Trial MEWS was trialled over 5 days for usability in Middlemore Hospital Delivery Suite and Maternity Ward, as well as tested retrospectively on Serious and Sentinel Event cases. All retrospectively reviewed cases would have triggered and received early intervention if this chart had been available and used.
Audits Currently we are in the process of evaluating the chart and refining our measurable aim.
ConclusionPPH cannot be prevented. It is axiomatic that PPH occurs unpredictably and no patient is immune from it.
What can be changed is how we react to and manage PPH. The introduction of a specific EWS for obstetrics combined with an evidence-based management model can potentially reduce the practice variability and improve the quality of care.
MEWS
Managers
Midwives
Nurses
Obstetricians
AnaesthetistsPatient at Risk Team
Clinical Training & Education
Centre
Midwife & Nurse
Educators
Acute Pain Team
IntroductionCM Health is introducing a systematic scoring chart for maternity patients to Women’s Health Service. The MEWS (Maternity Early Warning Score) chart will assist staff to identify antenatal and postnatal women at risk of deteriorating in condition and improve the response to the acutely deteriorating woman.
SettingCM Health serves the Counties Manukau region in Auckland, New Zealand. It has a birthing unit at Middlemore Hospital, one of the largest tertiary hospitals in New Zealand, and primary birthing units at satellite sites in Botany Downs, Papakura and Pukekohe. All primary birthing units offer pregnancy clinics, labour and birthing facilities and provide postnatal care.
• The estimated Counties Manukau population for 2013 is 512,130, 11.5% of the total New Zealand population.
• Counties Manukau has high numbers of Maaori, Pacific and Asian peoples and a relatively youthful population.
• Counties Manukau has a high birth rate compared with many other areas – 7282 babies were delivered in 2013 at CM Health. This contributes to relatively high demand on our maternity and child health services.(1)
MEWS Team Gail McIver, Quality Specialist Midwife, Delivery Suite Manager / Lesley Ansell, Associate Clinical Charge Midwife / Karen Clarke, Nurse Educator / Kathy Ogilvy, Nurse / Midwife Educator / Clare Kirby, Clinical Midwife Educator / David Ansell, Obstetric SMO / Sarah Wadsworth, Obstetric SMO / Louise Sherman, Obstetric Anaesthetist / Karla Masson, Acute Pain Nurse / Jenny Hunt, Acute Pain Nurse / Dwan Lee, Acute Pain Nurse / Susan Tareki, PAR Team / Tracey Cooper, CTEC / Tanya Wilson, Associate Clinical Charge Midwife / Tish Taihia, Associate Clinical Charge Midwife / Conny Krebs, Clinical Midwife Educator
References
(1) CMDHB website; (2) Robb & Sebbon (2010) A multi-faceted approach to the physiologically unstable patient. Qual Saf Health Care; 2010; 19; e47; (3) Carle, C., Alexander, P., Columb, M. et al (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; 2013; 68; pp. 354-367
Research Research indicates that warning signs precede virtually every critical inpatient event. There are well-established early warning score (EWS) charts in existence for use with general patients. A general EWS physiologically unstable patient chart was introduced at CM Health in 2007. (2)
However, EWS charts designed for general patients are unsuitable for use in obstetrics due to the physiological changes and modified responses that occur during pregnancy.
Although the importance of early warning scores for obstetric patients is widely recognised, there are no national or international ‘gold standards’ obstetric warning scores currently in use. (3)
Over the last four years midwives in the delivery suite observed an increase in major haemorrhages after birth, also known as postpartum haemorrhage(PPH), particularly major PPH over 1500mls. In too many cases, PPH was not managed in a timely manner to prevent women going down the continuum of deterioration, and patients became unstable.
Time to do something about it!
2010 2011 2012
148120
51
Maj
or H
aem
orrh
age
>
1500
mls
8171 8135 8103Birth Rate
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