Factors Influencing the Use of the Modified Early Warning Score (MEWS) to Identify Patient Deterioration

Abstract

Background: Approximately 80% of patients admitted to the ICU or requiring cardiopulmonary resuscitation display signs of deterioration up to 24 hours prior. Lack of timely recognition, response, and intervention for deteriorating patients increases patient mortality and poor outcomes. Rapid response teams (RRT) can be activated to avoid these outcomes, however only in 1 in 3 RRT activations occur in a timely fashion. Early warning score (EWS) systems such as modified early warning score (MEWS) have been proven to properly identify such patients and escalate care, but no such program is in place at Desert Regional Medical Center (DRMC). Purpose: The purpose of this project was to identify the factors influencing the adoption of the modified early warning score (MEWS) for detecting early patient deterioration and initiating proper escalation of patient care in progressive care unit (PCU) nurses. Methods: This was a quantitative descriptive project. Participants were day-shift PCU nurses at DRMC working on a unit treating a multitude of ill patients but primarily specializing in stroke patients. Nurses were given a pre-education questionnaire followed by education on the MEWS and its utility and were then asked to complete a post-education survey. Both pre- and post-education questionnaires/surveys were self-report measures with the post-education survey based on a Likert-type scale. Results: Analysis of questionnaire responses showed that 90% of nurses did not feel properly prepared for RRT situations and felt a lack of confidence. Lack of confidence in participating in a RRT situation was associated with feelings of insufficient training affecting confidence in clinical ability, concerns of rudeness from other doctors or nurses, chaos making them feel uncomfortable, and feelings of overwhelm or lack of time to manage the situation. After receiving education on the MEWS, 100% of nurses reported that implementation of this type of early warning tool would be beneficial for the hospital and was easy to follow. In addition, over 80% of nurses felt better prepared to identify patient deterioration, more confident to care for deteriorating patients, and more certain on when to activate RRT. Lastly, 86.7% of nurses reported that an early detection tool such as the MEWS had the potential to make their jobs easier. Conclusion: The MEWS is an evidence-based clinical prevention tool that can help nurses identify patient deterioration earlier, with more accuracy, and potentially increase their confidence in initiating or participating in a RRT situation if necessary. Research shows that implementation of early warning tools such as the MEWS is associated with improved patient outcomes, decreased mortality rates, and have been most successful when perceived to be necessary by hospital staff. Considering that DRMC nurses reported the need for an early warning system, the MEWS may be effectively implemented on this unit, and has the potential to not only improve patient outcomes but also improve nursing confidence in RRT participation. Results of this study can be used to guide future implementation of the MEWS into DRMC’s protocols and can inform the literature regarding nursing staff perceptions about early warning systems and participation in RRTs.