The Rapid Response Team and MEWS
Annual Nursing Research & Evidenced Based Practice Symposium
Decreasing Preventable Codes
September 10, 2009
By
Minnie Gaffney RN, CCRN
The Rapid Response Team and MEWS
Background
•
•
•
•
Initiated at NMH, January 2006
Nurse lead, dedicated team
Proactive
Wanted to impact patient care
Choices
• APACHE II
– ER/ICU population
– Lengthy
– Not all information available
–
for general population
Labor intensive for primary
floor nurses
• MEWS
– Easy short form for hand
–
–
calculations
All information easily
available
Readily accepted by RNs and
PCTs who assisted with trial
Modified Early Warning Score
3
2
1
0
<70
71-80
81-100
101-199
Heart Rate
(bpm)
<40
41-50
51-100
101-110
111-129
≥130
Respiratory
rate (bpm)
<9
9-14
15-20
21-29
≥30
Temperature
(°C)
<35
35-38.4
Systolic Blood
pressure
(mmHg)
AVPU score
Alert
1
2
3
≥200
≥38.5
Reacting to
Voice
Reacting to
Pain
Unresponsive
MEWS (Modified Early Warning Score)
3
<41
HR (bpm)
SpO2
SBP (mmHg)
1
<36°C
<96.8°F
Temp
RR (bpm)
2
<81
81-90
1
36-38°C
96.8-100.4°F
41-50
<10
<91%
0
2
3
>38°
>100.4°
51-100
101-110
111-129
>129
10-20
21-24
25-28
>28
161-170
171-180
>180
91-94%
95-100%
91-100
101-160
CAM
+
-
Resp Assessment
+
-
Total
Rapid Response Team goes Electronic
An electronic MEWS scoring patients based on vital sign data entered into PowerChart, was developed to
assist RRT RNs in their proactive identification of at-risk patients.
Rapid Response Team: Results
An observed reduction in average number of preventable codes per 1000 patient days has been achieved
since the implementation of the electronic MEWS; and on average an additional 250 patients are seen by
the RRT RN each month. To date 15,870 patients have been seen by RRT.
RRT Calls / Patients Seen
Preventable Codes Per Patient Days
500
(Lower is better)
450
1.2
400
1
350
300
0.8
250
0.6
200
150
0.4
100
0.2
50
Other
FY08
Linear (Preventable Codes/Pt Days)
1
2
FY
09
Q
4
Preventable Codes/Pt Days
MEWS Activations
FY
09
Q
3
FY
08
Q
1
4
3
2
1
4
2
FY
08
Q
FY
08
Q
FY
08
Q
FY
07
Q
FY
07
Q
FY
07
Q
FY
07
Q
FY
06
Q
FY
06
Q
Dec 08
Nov 08
Oct 08
Sept 08
Aug 08
July 08
June 08
May 08
April 08
Feb 08
Jan 08
Mar 08
Staff Activated
3
0
0
Rapid Response Team: Results
An observed reduction in average number of preventable codes per 1000 patient days has been
achieved since the implementation of the electronic MEWS; and on average an additional 250
patients are seen by the RRT RN each month. To date 15,870 patients have been seen by RRT.
Preventable Codes Per Patient Days
(Lower is better)
1.2
1
0.8
0.6
0.4
0.2
2
Q
1
F
Y
09
Q
4
F
Y
09
Q
3
F
Y
08
Q
2
F
Y
08
Q
1
F
Y
08
Q
4
F
Y
08
Q
3
F
Y
07
Q
2
F
Y
07
Q
1
F
Y
07
Q
4
Y
07
Q
F
Y
06
F
F
Y
06
Q
3
0
Preventable Codes/Pt Days
FY08
Linear (Preventable Codes/Pt Days)
Thank You!
• Pat Murphy, RN, MSN, MBA
• Kristin Ramsey RN, MSN, MPPM, NE-BC
• All of my Rapid Response Team colleagues, awesome
nurses!