Faster, better clinical care with the Resource Nurse team and MEWS

Faster, better clinical care with the Resource Nurse team and MEWS

Patients can destabilize in subtle, insidious ways: blood pressures slowly sag, the abdomen stays firm despite steady drainage of peritoneal fluid, lab values drift away from norms, urine output slows. “I feel weak,” says my patient. Indeed, she’s pale, and as winded as if she’d just climbed three flights of stairs, not pivoted three steps from the bedside commode to her bed. She’s mildly tachycardic, afebrile, lethargic but arouses to voice, answering questions appropriately. I scan through her chart. She was more or less like this yesterday. But something is not right, I sense.

I decide to consult the Resource Nurse (another recently implemented program) to discuss her worrisome symptoms, and then – as so often happens — Bobbie Bieler, the Resource Nurse, rounds the corner. She’s here to see my patient. Nursing intuition is real, yes, but Bobbie knew to check on my patient because of her high MEWS score.

The Modified Emergency Warning System, or MEWS, was recently added to inpatient charting at AAMC. It’s main purpose is to prevent delay in intervention or transfer of critically ill patients. The scoring algorithm is based on respiratory rate, heart rate, systolic blood pressure, consciousness level, temperature, and recent hourly urine output. Each admitted patient has a calculated, color-coded MEWS score (green=okay, yellow=warning, red=danger).

My patient’s MEWS score is eight – in the danger zone. Bobbie and I review the patient’s chart, discuss various topics (metabolic acidosis, the organ-crushing effect of intra-abdominal fluid pressure, and more), reassess the patient, and agree that alerting the covering hospitalist is appropriate. This puts into motion a series of discussions and events that ends with upgrading her care from acute to critical. She is quickly ordered pressors for blood pressure support.

The beauty of MEWS is that nurses need do nothing special to use the tool, other than include it as a column on their patient lists – which I now have in mine. The bright green, yellow, and red colors can’t be missed – helpful to both floor nurses (quicker diagnosis) and charge nurses (more effective patient management). The score is calculated using vital signs data, which is already routinely charted. And it’s real-time. So real, in fact, that Bobbie has to leave for a while to round on a different patient whose MEWS score has jumped to 11.

Nothing can fully replace critical thinking, clinical knowledge, and, of course, nursing intuition, but bedside nursing at AAMC feels very well supported by the resource nurse team and the MEWS scoring tool. With Bobbie and MEWS at my side, I feel much better equipped to recognize and intervene against potentially fatal septic shock for the patients in my care.

-Shirley Ebrahimian, MA, MS, RN

Agency for Healthcare Research and Quality (AHRQ) Innovations Exchange.
NIH National Institute of General Medicine Sciences.

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