THE ROYAL HOSPITAL

[Audio] Hello everyone and welcome to our meeting today. The theme of our discussion is an important one that directly impacts the care we provide to our patients at The Royal Hospital. As we all know the use of the Modified Early Warning Signs system is crucial in identifying and addressing any abnormal vital signs in our adult patients. Our goal is to improve patient outcomes and ensure the highest quality of care. So let's dive in and discuss the key aspects of this policy and how we can implement it effectively. I appreciate your attendance and am excited for a productive meeting..

[Audio] introduction. A Modified early warning sign refers to a track and trigger system where vital signs are recorded at the bedside and score is allocated to the vital signs that are outside of the normal range. The individual vital signs are added to a total MEWS and can then indicate the severity ofabnormal vital signs to assist in the identification of deteriorating patient. An increasing MEWS, if high enough, can trigger an escalation pathway for clinical review and management of he patient. A MEWS to be calculated each time a set of vital signs is performed. If there is a high frequency of recording vital signs (i.e. every 5-10 minutes)the total MEWS is to be calculated every 30 minutes as a minimum.

[Audio] Moving on to our third slide we have the quote 'purpose' which emphasizes the importance of providing clear guidance and instruction to our staff regarding the use of the adult mews system. Our C-C-O-T program aims to improve patient outcomes through early detection and intervention in cases of acute changes or deterioration. Hence it is crucial that mews is the default chart for all adult patients in the shifa system. Any concerns about its use should be discussed with the critical care team and documented in the patient's file. Let's now move on to the next slide which outlines the steps for using the mews system effectively..

[Audio] Slide number four will cover the scope of using the Modified Early Warning Signs system in our hospital. This system must be used for all adult in-patients including those in the maternity and emergency department. The adult mews chart is the default chart for all adult patients in our shifa system. If the mews scoring is deemed inappropriate it must be discussed with our critical care team. Also any decisions made must be documented in the patient's file. For further questions or concerns contact our critical care outreach team at 5019 which includes the Medical/Surgical Registrar ICU Registrar and I-C-U Consultant. Let us now move on to the next topic..

[Audio] Hello everyone and welcome to slide number 5. In this slide we will be discussing the policy of using the Modified Early Warning Signs or mews system in our hospital. It is a crucial policy that aims to improve patient outcomes by tracking and triggering abnormal vital signs in adult patients. This policy requires all patients to undergo routine bedside observations and record their physiological parameters hourly or as indicated by the doctor. This includes blood pressure temperature heart rate respiratory rate oxygen saturation level of consciousness and urine output. It is important to note that the nurse must always notify the outreach team when a trigger score of 4 is reached. The mews score is calculated by recording the individual scores for each parameter and then aggregating them. This score is used to identify patients who are at risk of developing critical illness. At our hospital we ensure that every patient has their observations monitored at least every 4 hours unless a decision has been made at a senior level to increase or decrease the frequency for individual patients. It is the responsibility of the registered nurse or doctor to determine the frequency of measuring and recording observations. The mews score must be applied after the initial observations are taken. This policy is crucial in identifying and responding to patients who are clinically deteriorating and it must be followed at all times. Let's move on to the next slide..

[Audio] Our policy at The Royal Hospital focuses on improving patient outcomes with the Modified Early Warning Signs (M-E-W-S-) system. This system tracks and alerts us of any abnormal vital signs in adult patients giving us a better understanding of their clinical progress. For emergency room patients mews is used after 2 hours from their initial presentation. In the operating theatre mews can be utilized before during and after surgery with frequent measurements taken. This policy applies to all emergency admissions unstable or concerning conditions frequent observation and chronic health problems. mews can also be used for post-op and day care patients. By consistently implementing this policy we can ensure our high-risk patients are monitored and potential critical illnesses are identified and addressed promptly. Let's continue striving for the best outcomes for our patients..

[Audio] Our next topic is slide number seven out of eighteen discussing the appropriate use of the mews system. It should be noted that there are certain situations where using mews is not appropriate such as with terminally ill patients those with a poor prognosis or those with a D-N-A-R order. Additionally if a patient is expected to be discharged within the next four hours using mews may not be necessary. In these cases the consultant must clearly communicate their decision by writing it on the observation chart or in the patient's progress notes. This ensures that all healthcare professionals are aware and can provide appropriate care. Moving on to the next slide unfortunately there is no available text as the summary is invalid..

[Audio] Today's meeting will focus on utilizing the Modified Early Warning Signs (M-E-W-S-) system to improve patient outcomes at The Royal Hospital. It is the responsibility of every nurse to conduct mews assessments using a standardized tool and document the scores in the patient's medical record. In case of a high mews score it is crucial to immediately notify the attending physician and the nurse in charge and implement appropriate interventions. All actions must be accurately reported in the patient's record. Moving on to the next slide which is confidential and should not be shared outside The Royal Hospital. Thank you..

[Audio] Our next topic is recording mews which is an essential part of monitoring our adult patients' vital signs. Consistently tracking and monitoring these signs is crucial for ensuring positive outcomes for our patients. This requires recording the mews score every 4 hours on either the standard observation chart or the computerized vital signs chart. This allows us to accurately assess the patient's condition and make timely decisions for their care. Remember to also document any decisions to initiate an outreach call in the patient's notes. This ensures that we are providing the best possible care for our patients. Let's move on to the next slide..

[Audio] Let's discuss how to respond to a mews trigger. The first step for nurses is to do everything possible to reduce the mews score. This may include providing oxygen to maintain SpO2 levels above 90% and repositioning the patient. However if these interventions are unsuccessful the mews flowchart must be followed. This involves calculating the mews score and taking appropriate actions as outlined in the flowchart. Effective communication is essential when dealing with a deteriorating patient. The I-S-B-A-R method should be used by staff to ensure clear and concise communication. This method includes identifying yourself stating the situation providing background information stating the assessment and making a recommendation for action. This allows for efficient and effective dialogue between healthcare professionals and can help improve patient outcomes. Remember responding to mews triggers is crucial in our efforts to improve patient outcomes. Let's continue to work together to ensure we are utilizing the mews system effectively and communicating efficiently..

[Audio] We have now reached slide number 11 which discusses how to respond to mews triggers. As healthcare professionals it is crucial for us to be prepared for potential medical emergencies in our patients. While waiting for patient review there are key things we must ensure. Accurate recording of vital signs is essential including monitoring oxygen levels and providing supplemental oxygen to maintain SpO2 levels above 90%. It is also important to have suction equipment readily available and attach a pulse oximeter to the patient when possible. In cases of high or low blood pressure hourly monitoring is necessary. For post-operative patients pain assessments should be conducted every two hours to ensure proper management. These seemingly small measures can greatly improve how we respond to mews triggers and ultimately enhance patient outcomes..

[Audio] Now shifting our focus to the next crucial policy it is imperative to acknowledge the importance of timely action towards abnormal vital signs. As indicated in our organization's Modified Early Warning Signs protocol in case of a delay or lack of response to the initial mews call within 10 minutes it is vital for the nursing staff to promptly alert the specialty team or contact the specialist nurse. And within 30 minutes a medical or surgical staff member must attend to assess the patient. Keeping this in consideration let us proceed to the next slide for additional information on this matter..

MEWS parameter chart:. Score 3 2 1 0 1 2 3 Resp rate </=8 9-20 21-30 31-35 >/=36 Temp </=34 34.1-35 35.1-36 36.1-37.9 38-38.5 38.6-40 >40 HR </=40 41-50 51-99 100-110 111-130 >/=131 S B/P </=70 71-80 81-100 101-160 161-199 >/=200 LOC A V P U UOPml/hr <20ml 20-29 ml 30-200ml >200ml SpO2 </=84 85-89 90-92 >/=93 A= alert V= responds to voice P= responding to pain U= unresponsiveness.

[Audio] In our discussion of the Modified Early Warning Signs system understanding the escalation pathway is crucial. This pathway includes key components that are necessary for swift and effective action. For mews scores of 1-3 patients will be observed every 1-2 hours. The mews score should be calculated and reported to the nurse in charge during these observations. If the mews score continues to increase it is important to consult with the medical staff for further intervention. Additionally if a patient's SpO2 drops below 90% oxygen should be administered immediately. For post-operative patients pain assessments should be done every 2 hours. Monitoring of systolic blood pressure may also be required. By following this escalation pathway we can ensure that any abnormal vital signs are promptly addressed to improve patient outcomes..

[Audio] Slide number 15 outlines the specific actions to be taken when a patient's mews score is 4 or higher. The first step is for the I/C or in-charge nurse to assess the patient followed by contacting the C-C-O-T and medical officer for a patient review within 30 minutes. The patient's observation should then be increased to 1-hour intervals for the next 3 readings with pulse oximetry included in the vital signs monitoring. It is important to calculate the mews score each time and strictly chart the patient's intake and output with increased monitoring if urine output is less than 20ml per hour or less than 30ml per hour in patients with catheters. If the patient's mews score remains at 5 for 3 consecutive readings transferring the patient to a higher level of care such as the high dependency unit may be necessary. These actions are crucial for the best possible outcomes for our adult patients. Moving on to the next slide the importance of early recognition and intervention in the use of the mews system will be discussed..

[Audio] Let's continue to work together to effectively use the mews system and provide the highest quality of care for our patients. Moving on to the next important step in our mews system: what to do when we encounter a mews score of 5 or higher. Immediate action must be taken to ensure the safety and well-being of our patients at this point. Contact the C-C-O-T (Critical Care Outreach Team) and inform the medical officer for assistance in reviewing the patient's condition and deciding the next course of action. Additionally the responsible consultant must be informed and the patient's vital signs monitored every 30 minutes to catch any changes or improvements. If the patient's mews score remains high for three consecutive readings transferring them to a higher level of care such as the High Dependency Unit (H-D-U--) may be necessary. Remember prompt action is crucial for the best outcome for our patients. Let's work together to use the mews system effectively and provide top-quality care for our patients..

[Audio] After discussing the significance of the mews system we should now understand the necessary actions to take when a mews score reaches or surpasses 8. The first step is to call C-C-O-T on Bleep Number 5019 which will notify both the registrar and consultant for a review of the patient's condition. It's also important to inform the I-C-U consultant to ensure appropriate care for the patient. We must have all relevant charts notes and recent investigations available for the consultant's review. Using the I-S-B-A-R communication tool is essential during this call. If necessary immediate medical intervention including C-P-R must be initiated. And if needed the patient should be transferred to a higher level of care such as I-C-U H-D-U or C-C-U--. Remember early intervention and effective communication are crucial for improving patient outcomes..

THANK YOU. Tying a bow in an arrangment of presents.