The Modified Early Warning Score - Essay Example

MEWS Assessment Tool 18 January Introduction It is a fact of life that most hospitals and other medical s are often not staffed to adequate levels. This is partly due to the general ageing of the population itself, in which there are now more senior people who are afflicted with various illnesses brought about by their advanced age, the increase in population, the prevalence of certain lifestyle diseases and a perception that medical health-related work is tiring and not adequately compensated. All in all, the shift in demographics plus fewer people entering the medical professions contributed to sometimes less than ideal working conditions in hospitals today. This often results in staff being overworked; working overtime in extended shifts and feeling harassed and tired after all the demands on them. A nurse’s judgment is often the key to patient survival (Gordon, 2006). The rationale of the essay expounding on the use of the MEWS or the modified early warning score assessment system is to address some of the pressing issues facing medical practitioners today. It is a serious attempt to reduce unnecessary deaths by the use of an early warning system based on a patients physiology to alert doctors, physicians and nurses to the urgency of a medical situation once a patients medical condition takes a turn for the worse and thereby avert a medical emergency through appropriate, timely intervention measures to save a patients life. The focus of the essays author is to encourage all to adopt the MEWS because it is designed as a tracking mechanism that will trigger automatic responses during an emergency to save lives. The MEWS uses a standardized scoring system that hopefully avoids costly mistakes resulting from poor judgements by medical personnel and serves as a patients live status report. MEWS works regardless of a nurse’s skill set mix (Mason et al., 2007). Discussion & Analysis The article cited a few disturbing statistics which are worth repeating here for the sake of emphasis. The numbers indicated how serious the situation is and how a proposed MEWS adoption will help improve those numbers drastically for the better. Among other things, this article cited a study which found why patients from a ward area have lower chances or rates of survival compared to patients coming from the A & E theatres. The reason could be quite obvious. In my view, this is because ward patients often get less than their desired medical attention compared to other patients. Ward patients, often by their sheer numbers, overwhelm a health workers attention, usually to the most important or the critical aspects of health care delivery. However, it must be pointed out here, it is not the fault of the health worker, who is simply might be attending to more patients. Medical practitioners need to focus on important things in todays fast-paced health care system environments (Hill & Howlett, 2004). These few statistics prove the usefulness and necessity of using MEWS: 41% of total admissions to intensive care were avoidable if there was earlier intervention; 69% of the total admissions were already in the late stages of critical illnesses and 54% of admissions had sub- optimal care prior. Whatever the reasons, MEWS is designed to address these issues by taking a more pro-active approach with regards to patients with already established or an impending critical illness. All this statistical evidence point out that timely interventions often spell the difference between life and death. What was lacking is a standardized system of monitoring these critically-ill patients when their conditions turn for the worse. The objectives of MEWS are two-fold: provide an early warning system for health workers to take action and empower nurses and junior medical staff to seek more experienced help from senior medical staff once the threshold trigger is reached regarding a patients condition. This system takes out much of guesswork and discretion by junior staff and makes the seeking of urgent help standardized. What MEWS is all about is really quite simple. Changes in a patients physiology are translated into a set of scores based on routine observations, things that are anyway normally done during the course of a patients stay in a hospital. The changes to be monitored and are to be recorded properly are pulse rate, blood pressure, body temperature, respiratory rate and the urine output. Included in MEWS are the Glasgow Coma Scale (GCS) and the AVPU system. At any rate, the MEWS system is easy enough to be done by any nurse or medical staff who has been properly trained to make the score and enter them into a patients chart. What MEWS does is translate all physiological changes into a simple-to-read and easy to understand system of scoring that alerts attending medical personnel to a possible emergency before it happens. It converts physiological observations into a single score so that a score of 4 or increase by 2 from a previous score automatically triggers an emergency response (NHS, 2007). Admittedly, the MEWS is not intended for every patient staying in a hospital. Among those considered ideal for it are unstable patients, all emergency admissions, all post operative patients and those afflicted with chronic health problems, among others. Those not considered for MEWS are patients who are already terminally ill, those who do not require observations, those about to be discharged and day-case patients. This process of categorizing who will be under MEWS or not will speed up the process by excluding patients obviously not needing these additional observations. MEWS even has potential for use at home, through the remote physiological monitoring of the same baseline measurements (Brender et al., 1996). The medical professional who made the decision not to use MEWS on a patient must note it on the front of the patients observation chart and the reasons or rationale why this is so through a simple and brief annotation. For patients who needs the MEWS, this will help also in the event they are transferred to another ward or to an external healthcare provider and alert the next medical provider about the patients overall conditions and what needs to be done. Actually, the MEWS is just another simple system of prioritizing medical care when it is in short supply, such as in hospitals where there are an unusual number of patients and few medical staff to attend to them. However, this situation is not an excuse to delay urgent care as there are certain protocols to be followed once the MEWS is triggered by a rise in the score of a patient. For example, a score of 4 or an increase by 2 from the previous score should trigger an urgent referral for review by the competent medical staff. This procedure is to be followed whether during daytime or night time. The nursing staff should issue medical emergency calls within ten minutes to the relevant speciality team concerned. A member of the medical staff must attend to the patient within thirty minutes from the time of the call and assess the patient within the said allotted time period. MEWS is nothing but sort of a simple triage system. The whole concept of using MEWS is prevention through the use of an early warning system and it is even useful in A & E departments for patients who might be discharged inappropriately. Most admissions in observation wards are short-stay only and MEWS is used (Raftery, 1997). Through the use of a numerical scoring system, MEWS is an attempt to accomplish several things at once. It allows for early interventions on patients before their conditions get worse and also allows for the more efficient allocation of scarce or insufficient resources in a hospital setting. This modified early warning score system makes for speed and accuracy in the treatment of patients whose conditions may have deteriorated and improves their chances for survival when every minute counts and accurate information is very crucial in this period. Hopefully, the use of MEWS will result in a higher level of medical care resulting from better communications among the various units involved in health care delivery. Using standardized scores support in securing urgent medical care for sick patients and is also an aid to enhancing better medical judgements. MEWS should be used with caution and is not a substitute for good judgement or an a good triage system that screens patients initially (Wilkins, 1983). Conclusion There are many benefits to be derived from the adoption and full implementation of the MEWS in all medical institutions. Primarily, it is a very good tool in assessment of ward patients before their physical conditions deteriorate for the worse while still in the wards by providing medical attendants with a good warning system. This helps to prevent unnecessary or avoidable deaths when these patients are admitted into intensive care units by using MEWS as a preventive measure through the provision of early interventions. The use of MEWS can be pretty straightforward while delivering maximum benefits. For one, it is very easy to learn. Once nursing and medical staff are trained how to use it on their patients properly, it can be integrated into the patients Standard Observation Chart. The use of MEWS can make life pleasant for everyone concerned, from the medical provider by eliminating much of the guesswork and discretionary judgements that makes them prone to errors and also benefits the patients the most by making early interventions available to them. MEWS has the potential to make healthcare delivery more standardized and at the same time raise this to a higher level. Additionally, this early warning scoring system can help to avoid the usual finger-pointing and blaming if something goes wrong with a patient. In conclusion, MEWS should be used in all medical institutions because it is effective yet very simple to use. Even nurses can be trained to do it and the additional recording and the monitoring of a patients physical condition helps to improve the accuracy of information that is made available to the medical practitioners and providers. The training is incorporated into the core curriculum by teachers and instructors for those aspiring to be in the medical service professions. Nursing staff will be trained during the local induction and also more specifically when they are assigned to local wards or departments. Within clinical practice, MEWS can be implemented without any major hitches because it is simple and forms part of assessments. References Brender, Jytte, Christensen, J. P. and Scherrer, J. R. Medical Informatics Europe 96: Human Facets in Information Technologies. Sawbridgeworth, Herts, UK: IOS Press, 1996. p. 63 Gordon, Suzanne. Nursing Against the Odds: How Health Care Cost Cutting, Media Stereotypes and Medical Hubris Undermine Nurses and Patient Care, Ithaca, NY: Cornell University Press, 2006. p. 97 Hill, Signe S. and Howlett, Helen A. Success in Practical/Vocational Nursing: From Student to Leader. Jordan Hill, Oxford, UK: Elsevier Health Sciences, 2004. p. 67 Mason, Diana J., Leavitt, Judith Kline and Chaffee, Mary W. Policy and Politics in Nursing and Health Care. Jordan Hill, Oxford, UK: Elsevier Health Sciences, 2007. p. 554 Raftery, James. Healthcare Needs Assessment: Second Series. Abingdon, Oxon, UK: Radcliffe Publishing, 1997. p. 28 Royal Bournemouth and Christchurch Hospitals, National Health Service Foundation Trust, Policy for the Use of the Modified Early Warning Score (MEWS), Trust Policy, VS January 2007, JS&MCT. Wilkins, Earle W. and Massachusetts General Hospital. MGH Textbook of Emergency Medicine: Emergency Care as Prescribed at the Massachusetts General Hospital. Waterloo Road, London, UK: Williams & Wilkins, 1983. p. 879. Read More