While some submissions have included only the MEOWS charts, others have included the background physiological changes in pregnancy, rationale behind the MEWS scores and an audit tool to check compliance with the scoring system.
General points
The introduction of Early Warning Scores is intended to identify sick women and initiate action at a time when treatment might make a difference.
Most submissions follow the general pattern of colour coding for the various vital signs with guidance on what to do if the serious signs were triggered.
The colour trigger (2 yellows or a red) is simple and visual. A numerical score is more complex and dependent on additional skills .
Signs included are temperature, systolic blood pressure, pulse rate, respiratory rate, neuro scores, and oxygen saturation.
Variability in upper and lower limit of triggers between charts as limited validation of variables in pregnancy.
The explanations of how to apply the system vary in the amount of detail but in some cases are too extensive to be consulted at the bedside.
Balance between too much information on a chart causing distraction and maximising useful variables recorded.
Some charts include observations and information relevant to analgesia/opioid use rather than just physiology.
We liked
Red as the colour denoting serious patient condition requiring urgent action.
Amber as the colour suggesting that the patient condition is worsening requiring escalation of treatment.
Diastolic pressure being included in the chart. ( Lothian, Sheffield) with clear instructions in eclamptics.
Brief summary of how to assess BP in pregnant patient (Lothian)
In case of known chronic health abnormality in a woman, a modified trigger score may be applied (Sheffield)
Having scores for “Looks unwell” as this allows a staff member to ask for help if in doubt.
Clear response algorithm explaining the action plan if patient triggers.
Instructions when to use charts and frequency of observations required in differing situations / conditions.
Having local bleep numbers of doctors on the chart.
A simple chart is more likely to encourage compliance, particularly from staff with no previous exposure to critical care.
Respiration as the first sign on the chart to be recorded as this signifies importance and is generally the most overlooked sign.(Birmingham)
Trigger for heart rate > systolic Bp (Birmingham)
Uterine tone and PV loss as additional signs.
Hourly observation of RR, pain scores, saturations etc for 12 hours is required if intrathecal opiate or PCA opiate is used.(Lothian)
We didn't like
Urine output not being included.(Birmingham)
Suggesting how many reds and ambers are required to trigger referral is easier to follow than having a number to calculate i.e. SEWS score which then triggers referral.(Lothian)
Not having BP as an observation on the chart.
Absence of colour coding and reliance on numerical scores to trigger referral. This is not visually appealing and as effective as colours.
Colour should not be so intense that chart entries are hard to see.
Not combining the scores with the observation chart. Separate calculation of the scores to trigger referral may be an added effort for staff.(Sheffield)
We're not sure
Calculation of urine output on basis of body weight – very useful but complex for midwifery staff to apply.
Crowding with physiological variables has a negative effect on legibility.
Green as a colour denoting no further action required other than regular observations. (Birmingham).Generally white is used to denote this.
Too many colours to denote various grades of urgency.
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