MEWS to help identify sick patients in the pre-hospital environment
PHECC has introduced the Modified Early Warning Score(MEWS) for Practitioners as part of the 3rd Edition CPGs. MEWS will help to identify patients who have the potential to become acutely unwell without early interventions. In the western world MEWS is commonly used for the assessment of unwell hospital patients in non-acute wards.
MEWS is a simple scoring system that can be calculated using parameters which are measured for all acute patients. See table below. It can be used to quickly identify patients who are clinically deteriorating and who need urgent intervention. MEWS can also be used to monitor medical patients during assessment and transport. The use of MEWS has been shown to be effective in reducing mortality and morbidity of patients who deteriorate slowly.
| |
Modified Early Warning Score (MEWS) |
|
| |
Score |
3 |
2 |
1 |
0 |
1 |
2 |
3 |
|
| |
Resp Rate |
|
<9 |
|
9-14 |
15-20 |
21-29 |
<29 |
|
| |
Heart Rate |
|
<41 |
41-50 |
51-100 |
101-110 |
111-129 |
<129 |
|
| |
Sys Bp |
|
71-80 |
81-89 |
90-159 |
160-169 |
170-199 |
<199 |
|
| |
Temp |
<71 |
<35 |
|
35-38.4 |
|
<38.4 |
|
|
| |
AVPU |
|
|
|
Alert |
Voice |
Pain |
Unresponsive |
|
| |
A score of 5 or more is a marker for immediate transport |
|
When is MEWS used?
A MEWS should be calculated for any patient who the Practitioner is concerned about. Repeated measurements can track the patient’s clinical status following interventions such as oxygen therapy, airway maintenance or further deterioration. Several MEWS readings are more informative than a single reading as they give a picture of the patient’s clinical status over time. The MEWS system has been adopted by PHECC to assist Practitioners in identifying potentially unwell patients. Once an unwell patient has been identified, with a MEWS of 5 or more, the clinical status of the patient should be upgrade to ‘Life Threatening’, should stimulate a immediate transport to the Emergency Department (ED) and an early request for Advanced Life Support (ALS). Once all the parameters for a patient are entered into the tablet PC the MEWS will be automatically calculated for each patient. This is another PHECC initiative to assist the Practitioner to enhance patient care. For information on how to calculate a MEWS for a patient go to
www.phecc.ie