Maternal bacteremia and the Irish maternity early warning system

Maguire, Patrick; O’Higgins, Amy; Power, Karen A.; Daly, Niamh; McKeating, Aoife; Turner, Michael J.

doi:10.1016/j.ijgo.2014.11.022

Cited by 32 publications

(27 citation statements)

References 15 publications

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“…The completion of the RI and MEOWS tool by 77% of participants suggests an adequate feasibility. Our result was consistent with other previous studies although the level of completeness of our study was not as substantial as in other studies like the study done in UK, Ireland, and Zimbabwe that reported an improvement in the frequency of documentation of vital signs, the time interval between trigger and antibiotic administration, and pre-operative stabilization of women undergoing caesarean section following the implementation of the Early Warning Signs (EWS) tool (Cantwell et al, 2008;Maguire et al, 2015;Merriel et al, 2017).…”

Section: Discussionsupporting

confidence: 93%

“…This suggests that early recognition of patients at high risk of complications might allow earlier transfer before the development of complications and speed up the access to care at higher level by minimizing delays through easy situation awareness, communication, and decision making among teams. For example, studies done in Ireland and Zimbabwe reported an improvement in the time interval between trigger and antibiotic administration, and pre-operative stabilization of women undergoing caesarean section following the implementation of the Early Warning Signs (EWS) tool (Maguire et al, 2015;Merriel et al, 2017).…”

Section: Introductionmentioning

confidence: 99%

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Implementing the Risk Identification (RI) and Modified Early Obstetric Warning Signs (MEOWS) tool in district hospitals in Rwanda: A cross-sectional study

Tuyishime

Ingabire

Mvukiyehe

et al. 2020

Preprint

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Background: Despite reaching Millennium Development Goal (MDG) 3, the maternal mortality rate (MMR) is still high in Rwanda. Most deaths occur after transfer of patients with obstetric complications from district hospitals (DHs) to referral hospitals; timely detection and management may improve these outcomes. The RI and MEOWS tool has been designed to predict morbidity and decrease delay of transfer. Our study aimed: 1) to determine if the use of the RI and MEOWS tool is feasible and acceptable in DHs in Rwanda and 2) to determine the role of the RI and MEOWS tool in predicting morbidity.Methods: A cross-sectional study enrolled parturient admitted to 4 district hospitals during the study period from April to July 2019. Data was collected on compliance rate to RI and MEOWS tool, acceptability, and prediction of morbidity (hemorrhage, infection, and pre-eclampsia).Results: Among 798 parturient enrolled in this study, the mean age was 20.3 years (Sd=6.8), most of them had insurance (95%), the mean of length of stay was 3.1 days (Sd=2.08), and the morbidity rate was 10.3%. The RI and MEOWS tool compliance rate was 76.3 and acceptability rate among 22 respondents was 90.9%. The RI and MEOWS tool had accuracy of 14.29%, P value <0.001, relative risk of 0.277 42 (0.1718-0.4487), sensitivity of 73.68%, specificity of 93.86%, positive predictive value of 11.57%, and negative predictive value of 41.67% .Conclusion: RI and MEOWS tool is a feasible and acceptable in the DHs of Rwanda. In addition, having moderate or high scores on the RI and MEOWS tool predict morbidity. After consideration of local context, this tool can be considered for scale up to other district hospitals in Rwanda or other low resources settings.

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Implementing the Risk Identification (RI) and Modified Early Obstetric Warning Signs (MEOWS) tool in district hospitals in Rwanda: A cross-sectional study

Tuyishime

Ingabire

Mvukiyehe

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…3 Others trigger the same response when one or more markedly abnormal, or two or more mildly abnormal, observations are present. 13,14 These systems are frequently used alongside charts featuring colour-coded shading to highlight the markedly and mildly abnormal vital signs ranges, often shaded in red and yellow, respectively ( Figure 1). 1, 15 A third type of ObsEWS allocates points in a weighted manner, based on the derangement of a woman's measured vital signs from pre-defined 'normal' ranges (Table 1).…”

Section: -10mentioning

confidence: 99%

Vital signs and other observations used to detect deterioration in pregnant women: an analysis of vital sign charts in consultant-led UK maternity units

Smith

Isaacs

Andrews

et al. 2017

International Journal of Obstetric Anesthesia

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“…This suggests that early recognition of patients at high risk of complications might allow earlier transfer before the development of complications and speed up the access to care at higher level by minimizing delays through easy situation awareness, communication, and decision making among teams. For example, studies done in Ireland and Zimbabwe reported an improvement in the time interval between trigger and antibiotic administration, and preoperative stabilization of women undergoing caesarean section following the implementation of the Early Warning Signs (EWS) tool [4,5].…”

Section: Introductionmentioning

confidence: 99%

Implementing the Risk Identification (RI) and Modified Early Obstetric Warning Signs (MEOWS) tool in district hospitals in Rwanda: a cross-sectional study

Tuyishime

Ingabire

Mvukiyehe

et al. 2020

BMC Pregnancy Childbirth

View full text Add to dashboard Cite

Background Despite reaching Millennium Development Goal (MDG) 3, the maternal mortality rate (MMR) is still high in Rwanda. Most deaths occur after transfer of patients with obstetric complications from district hospitals (DHs) to referral hospitals; timely detection and management may improve these outcomes. The RI and MEOWS tool has been designed to predict morbidity and decrease delay of transfer. Our study aimed: 1) to determine if the use of the RI and MEOWS tool is feasible in DHs in Rwanda and 2) to determine the role of the RI and MEOWS tool in predicting morbidity. Methods A cross-sectional study enrolled parturient admitted to 4 district hospitals during the study period from April to July 2019. Data was collected on completeness rate (feasibility) to RI and MEOWS tool, and prediction of morbidity (hemorrhage, infection, and pre-eclampsia). Results Among 478 RI and MEOWS forms used, 75.9% forms were fully completed suggesting adequate feasibility. In addition, the RI and MEOWS tool showed to predict morbidity with a sensitivity of 28.9%, a specificity of 93.5%, a PPV of 36.1%, a NPV of 91.1%, an accuracy of 86.2%, and a relative risk of 4.1 (95% Confidential Interval (CI), 2.4–7.1). When asked about challenges faced during use of the RI and MEOWS tool, most of the respondents reported that the tool was long, the staff to patient ratio was low, the English language was a barrier, and the printed forms were sometimes unavailable. Conclusion The RI and MEOWS tool is a feasible in the DHs of Rwanda. In addition, having moderate or high scores on the RI and MEOWS tool predict morbidity. After consideration of local context, this tool can be considered for scale up to other DHs in Rwanda or other low resources settings. Trial registration This is not a clinical trial rather a quality improvement project. It will be registered retrospectively.

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Maternal bacteremia and the Irish maternity early warning system

Abstract: Among pregnant women with proven bacteremia, introduction of IMEWS has been associated with an improvement in the recording of vital signs, particularly respiratory rate.

Cited by 32 publications

References 15 publications

Implementing the Risk Identification (RI) and Modified Early Obstetric Warning Signs (MEOWS) tool in district hospitals in Rwanda: A cross-sectional study

Implementing the Risk Identification (RI) and Modified Early Obstetric Warning Signs (MEOWS) tool in district hospitals in Rwanda: A cross-sectional study

Vital signs and other observations used to detect deterioration in pregnant women: an analysis of vital sign charts in consultant-led UK maternity units

Implementing the Risk Identification (RI) and Modified Early Obstetric Warning Signs (MEOWS) tool in district hospitals in Rwanda: a cross-sectional study

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