The effect of implementing a modified early warning scoring (MEWS) system on the adequacy of vital sign documentation

Hammond, Naomi E., Spooner, Amy J., Barnett, Adrian G., Corley, Amanda, Brown, Peter and Fraser, John F. (2013) The effect of implementing a modified early warning scoring (MEWS) system on the adequacy of vital sign documentation. Australian Critical Care, 26 1: 18-22. doi:10.1016/j.aucc.2012.05.001

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Author Hammond, Naomi E.
Spooner, Amy J.
Barnett, Adrian G.
Corley, Amanda
Brown, Peter
Fraser, John F.
Title The effect of implementing a modified early warning scoring (MEWS) system on the adequacy of vital sign documentation
Journal name Australian Critical Care   Check publisher's open access policy
ISSN 1036-7314
Publication date 2013-02
Year available 2013
Sub-type Article (original research)
DOI 10.1016/j.aucc.2012.05.001
Open Access Status
Volume 26
Issue 1
Start page 18
End page 22
Total pages 5
Place of publication Philadelphia, PA, United States
Publisher Elsevier
Collection year 2014
Language eng
Formatted abstract
Introduction and objectives: Early recognition of deteriorating patients results in better patient outcomes. Modified early warning scores (MEWS) attempt to identify deteriorating patients early so timely interventions can occur thus reducing serious adverse events. We compared frequencies of vital sign recording 24 h post-ICU discharge and 24 h preceding unplanned ICU admission before and after a new observation chart using MEWS and an associated educational programme was implemented into an Australian Tertiary referral hospital in Brisbane.
Design: Prospective before-and-after intervention study, using a convenience sample of ICU patients who have been discharged to the hospital wards, and in patients with an unplanned ICU admission, during November 2009 (before implementation; n = 69) and February 2010 (after implementation; n = 70).
Main outcome measures: Any change in a full set or individual vital sign frequency before-and-after the new MEWS observation chart and associated education programme was implemented. A full set of vital signs included Blood pressure (BP), heart rate (HR), temperature (T), oxygen saturation (SaO2) respiratory rate (RR) and urine output (UO).
Results: After the MEWS observation chart implementation, we identified a statistically significant increase (210%) in overall frequency of full vital sign set documentation during the first 24 h post-ICU discharge (95% CI 148, 288%, p value <0.001). Frequency of all individual vital sign recordings increased after the MEWS observation chart was implemented. In particular, T recordings increased by 26% (95% CI 8, 46%, p value = 0.003). An increased frequency of full vital sign set recordings for unplanned ICU admissions were found (44%, 95% CI 2, 102%, p value = 0.035). The only statistically significant improvement in individual vital sign recordings was urine output, demonstrating a 27% increase (95% CI 3, 57%, p value = 0.029).
Conclusions: The implementation of a new MEWS observation chart plus a supporting educational programme was associated with statistically significant increases in frequency of combined and individual vital sign set recordings during the first 24 h post-ICU discharge. There were no significant changes to frequency of individual vital sign recordings in unplanned admissions to ICU after the MEWS observation chart was implemented, except for urine output. Overall increases in the frequency of full vital sign sets were seen.
Keyword Modified early warning scores (MEWS)
Intensive care
Vital signs
Deteriorating patients
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2014 Collection
School of Medicine Publications
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Citation counts: TR Web of Science Citation Count  Cited 9 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 15 times in Scopus Article | Citations
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