Modified early warning scoring (<scp>MEWS</scp>): evaluating the evidence for tool inclusion of sepsis screening criteria and impact on mortality and failure to rescue

Roney, Jamie K.; Whitley, Barbara E; Maples, Jessica; Futrell, Lexie Scarborough; Stunkard, Kimberley A.; Long, JoAnn D.

doi:10.1111/jocn.12952

Cited by 42 publications

(34 citation statements)

References 20 publications

(33 reference statements)

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“…In addition to their potential use following an ICU admission, wearables may also play a role in monitoring inpatients for signs of clinical deterioration, so as to identify as soon as possible any patient needing a higher level of care. Early Warning Systems (EWS) have been developed to address a “failure to rescue” problem, in which critical illness is identified too late [ 21 ]. Wearable devices stand to enhance data collection and monitoring both prior to and following an ICU admission, and as such is of growing importance in critical care research.…”

Section: Discussionmentioning

confidence: 99%

Use of wearable devices for post-discharge monitoring of ICU patients: a feasibility study

et al. 2017

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BackgroundWearable devices generate signals detecting activity, sleep, and heart rate, all of which could enable detailed and near-continuous characterization of recovery following critical illness.MethodsTo determine the feasibility of using a wrist-worn personal fitness tracker among patients recovering from critical illness, we conducted a prospective observational study of a convenience sample of 50 stable ICU patients. We assessed device wearability, the extent of data capture, sensitivity and specificity for detecting heart rate excursions, and correlations with questionnaire-derived sleep quality measures.Results Wearable devices were worn over a 24-h period, with excellent capture of data. While specificity for the detection of tachycardia was high (98.8%), sensitivity was low to moderate (69.5%). There was a moderate correlation between wearable-derived sleep duration and questionnaire-derived sleep quality (r = 0.33, P = 0.03). Devices were well-tolerated and demonstrated no degradation in quality of data acquisition over time.ConclusionsWe found that wearable devices could be worn by patients recovering from critical illness and could generate useful data for the majority of patients with little adverse effect. Further development and study are needed to better define and enhance the role of wearables in the monitoring of post-ICU recovery.Trial registrationClinicaltrials.gov, NCT02527408 Electronic supplementary materialThe online version of this article (10.1186/s40560-017-0261-9) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Use of wearable devices for post-discharge monitoring of ICU patients: a feasibility study

et al. 2017

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“…A large observational study with hospitalized patients has shown that 9% had at least one clinically abnormal vital sign or adverse event in early stages of admission (Buist, Bernard, Nguyen, Moore, & Aderson, 2004). Mortality rates have been associated with signs missed during admission and hospitalization (Roney et al, 2015).…”

Section: Introductionmentioning

confidence: 99%

The value of the Modified Early Warning Score for unplanned Intensive Care Unit admissions of patients treated in hospital general wards

Zografakis-Sfakianakis

Bree

Linardakis

et al. 2018

Int J of Nursing Practice

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“…In conjunction with an academic‐clinical partnership, a team of frontline nurses, led by the hospital sepsis coordinator and mentored by a nurse scientist systematically searched and evaluated the scientific literature to validate key components of existing MEWS tools for inclusion of sepsis criteria. The details and results of this process and findings from phase one of the project have been published elsewhere . Organizational approval for the evidence‐based quality improvement project followed institutional policy and processes.…”

Section: Methodsmentioning

confidence: 99%

Implementation of a MEWS‐Sepsis screening tool: Transformational outcomes of a nurse‐led evidence‐based practice project

2019

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Background: One in three patients who die in the hospital has sepsis. Alerting clinicians to early detection of high-risk patients before deterioration is a top health care priority. Modified Early Warning Scoring (MEWS) tools have assisted organizations in identifying at-risk patients at the first sign of subtle deterioration.Aim and setting: In conjunction with an academic-clinical partner, we evaluated, revised and implemented a modified MEWS-Sepsis screening tool in an acute care facility.Participants: One hundred and thirty-nine direct-care nurses participated in tool evaluation.Methods: Using a plan-do-study-act cycle of quality improvement, critical care scenarios from septic patient data were created and tested in a simulated setting.Results: Upon implementation of the MEWS-Sepsis tool, the monthly risk-adjusted sepsis mortality rate immediately declined by 24%. The decline in mortality has been sustained from implementation to the present, spanning a 5-year period. Conclusions: The implementation of a MEWS-Sepsis screening tool contributed to early identification and implementation of time-sensitive interventions aimed at preventing sepsis-associated deaths. MEWS-Sepsis tools hold potential for scale-up and spreading out of evidence-based practice nursing innovations to transform care, improve patient outcomes, and save lives. K E Y W O R D S academic/service partnerships, critical care, evidence-based, quality improvement

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Modified early warning scoring (MEWS): evaluating the evidence for tool inclusion of sepsis screening criteria and impact on mortality and failure to rescue

Cited by 42 publications

References 20 publications

Use of wearable devices for post-discharge monitoring of ICU patients: a feasibility study

Use of wearable devices for post-discharge monitoring of ICU patients: a feasibility study

The value of the Modified Early Warning Score for unplanned Intensive Care Unit admissions of patients treated in hospital general wards

Implementation of a MEWS‐Sepsis screening tool: Transformational outcomes of a nurse‐led evidence‐based practice project

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