MEWS: Creating a Better Early Warning Score for Sepsis
The Early Warning Score was first introduced in 2001 and has subsequently been modified to the “Modified Early Warning Score,” or MEWS. There is also a pediatric version (PEWS) of the warning score, and one for obstetrical patients (OBEWS).
The MEWS score is based upon common vital signs, as well as nursing assessments of mental status, urine output and/or age/BMI. A normal vital sign is scored a zero and above; a below normal is scored a 1 or 2 based upon how far from normal they are. These scores are summed up and recorded by the nurse every time a patient’s vital signs are checked. MEWS is not specific to sepsis, but it is an indicator of general instability / level of illness for the patient.
MEWS was first introduced to the health system at Southside Hospital by Dr. Jay Enden and team. It was brought to the sepsis task force and then presented by Ms. Rita Mercieca to the Nurse Executive Committee, where the concept of broad rollout within the health system was embraced with a desire to have it available within the EMR to minimize the potential increase on bedside RN work.
MEWS has been rolled out at Forest Hills Hospital in paper form and piloted at Glen Cove Hospital where it was the focus of one of the Harvard Project Management work groups. The GCH team along with the HPM team created template project planning tools for use by other facilities and adapted a tool from the NHS in Britain obtained through the Global Sepsis Alliance (of which North Shore-LIJ is a member) to define a sepsis screening process based upon a MEWS score equal or greater than three. Cohen’s Children’s Medical Center (CCMC) has also piloted (on paper) PEWS on one of their units.
The Office of the CIO (OCIO) has been working on incorporating MEWS and PEWS into the Sunrise Clinical Manager (SCM) for several months and has successfully built the medical logic module (MLM) for this based upon work from the team at the University of Kentucky (an SCM site) and scientific work from Northwestern University. This work is being led by Dr. Kevin Bock and Dr. Michael Oppenheim. At this writing the North Shore-LIJ MEWS MLM is sending alerts for scores > 3 to a database and Dr. Bock’s email for further analysis and validation. The EMR version of MEWS is projected to be in final form by the time that the EMR sites are prepared to adopt it.
A MEWS task force has been in existence under Dr. Bock’s leadership for several months to align the decisions of all of the MEWS projects. Members of the sepsis task force are highly involved in creating a strong linkage between these activities. This team has recently been expanded, the GCH/ Harvard PM template materials have been disseminated and planning discussions are beginning or ongoing at most facilities. There is also communication between the SCM team and the Huntington Hospital McKesson EMR team to transfer the MLM details to that site. The MEWS rollout will be the second focus of the IHI partnership after the initial project in the EDs has matured.