Reliability Testing of a Modified Early Warning Scoring (MEWS)

Thursday, 25 July 2013: 9:10 AM

Erin Whitley, BSN, RN1
Jamie K. Roney, BSN, RN, CCRN2
Lexie Scarborough Futrell, MSN, RN, CCRN3
Jessica Maples, BSN, RN2
Kimberley A. Stunkard, RN3
JoAnn D. Long, RN, PhD, NEA-BC4
(1)Department of Critical of Care, Covenant Health, Lubbock, TX
(2)Nursing Administration, Covenant Health, Lubbock, TX
(3)Department of Critical Care Nursing, Covenant Health, Lubbock, TX
(4)Department of Nursing, Lubbock Christian University, Lubbock, TX

Learning Objective 1: The learner will be able to discuss the reliability testing of an adapted evidence-based Modified Early Warning Scoring (MEWS) tool.

Learning Objective 2: The learner will be able to discuss Modified Early Warning Scoring (MEWS) tool reliability testing results with implication to nursing practice.

Purpose: Research was guided by Institute for Healthcare Improvement’s Transforming Care at the Bedside framework. Evidence suggests clinical signs of patient deterioration may appear hours before life-threatening events occur.  Subtle changes may go undetected in hospitals contributing to an estimated 98,000 annual preventable deaths.  Previous research indicates the use of early warning scoring systems (EWSS) may decrease the incidence of cardiopulmonary arrest in the hospitalized patient if used to identify and treat the at-risk for deterioration individual.  Hospitals worldwide have adapted EWSS to address the problem; however, few prospective studies have reported reliability testing of modified instruments adapted to meet organizational needs.  The purpose of this study was to test the reliability of a modified early warning scoring (MEWS) tool adapted for a 1,005 bed acute care urban hospital without a current screening process to identify patients at-risk for deterioration. The purpose for this study was to identify whether utilizing four simulated patient scenarios would demonstrate reliability of the MEWS tool in scoring and following the associated algorithm.

Methods: Reliability testing of a developed MEWS tool in a mock hospital low-fidelity simulation setting with clinical data from septic hospitalized patients was used. 

Results: Reliability between total scores in each MEWS color in the simulated scenarios ranged from Green 88%, Yellow 92%, Orange 72%, and Red 76%. Analysis of the research question from a convenience sample of (n=25) nurses indicate the entire MEWS tool had a Cronbach’s alpha level of 0.76. 

Conclusion: The reliability results are acceptable. Variance in results between the scenarios suggests that further education may be needed as patient complexity increases. The ultimate goal for the research team includes assurance that evidence-based practice measures are incorporated into the MEWS tool physiological assessment findings and associated algorithms to identify the at-risk for deterioration patient earlier, thus positively impacting mortality.