Sometimes when bad things happen, it can lead to
changes to help prevent poor outcomes in the future. This is true for sepsis care in New York State. NYS is the first state to apply
mandated laws for hospitals to set in place protocols for sepsis care. The NYS
push comes from a 12 year old boy who died as a result of early warning signs
of sepsis being missed. Click here to read more about Rory and how his parents
have been advocates to prevent this from happening again.
As part of the NYS regulations hospitals must have
protocols in place to help identify early warning signs of sepsis- (8)
hospitals shall have in place evidence-based protocols for the early
recognition and treatment of patients with severe sepsis and septic shock that
are based on generally accepted standards of care as required by subdivision
(a) of section 405.4 of this Part. Patients who are identified and treated
earlier have improved survival outcomes from sepsis (Tazbit, 2012).
One way to
complete this is to use a tool called Modified Early Warning System or MEWS for
short. MEWS is a tool which assists
healthcare personnel to identify the early signs of sepsis. MEWS takes key
vital signs/assessments and alerts practitioners when the there is a change in
vital signs. Changes in vital signs may be subtle; therefore practitioners are
less likely to pick up the slight changes.
Here is what a MEWS adult score card can look like:
Pediatric monitoring can be more difficult to the
varying vital signs for every age group.
Here is a sample for the pediatric monitoring tool.
Facilities who are using electronic health records
(EHR) can integrate the monitoring tools into the EHR to continuously monitor
patients for changes. The healthcare system that I currently work for has built
this into our EHR and practitioners are given a best practice alert for changes
in the MEWS. The nursing staff is alerted when there is a change in the MEWS
score with a protocol for the response.
Whether using the adult or pediatric monitoring tool
it is always important to remember the early warning systems are tools to help
us care for the patients, but we must always use critical thinking and good
assessment skills. Nurses should notify the physician with changes in patients
or a gut feeling something is not right. Tools cannot always pick up subtle
changes that the human-human interface can.
Tazbir, J. (2012). Early
Recognition and Treatment of Sepsis in the Medical-Surgical Setting...
[published erratum appears in MEDSURG NURS; 2012 Sep-Oct; 21(5): 270]. MEDSURG
Nursing, 21(4), 205-209.
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