Early warning scores in cardiac arrest patients

Abstract

Background: Significant physiological deterioration in the 8 hours pre arrest is evident in 84% of in-hospital cardiac arrests. The modified early warning score (MEWS) is an example of a physiological ‘track and trigger’ system designed to identify patients at risk of clinical deterioration. Aims: The primary aim of this study was to describe the use and characteristics of the MEWS score in the 24-hour period preceding cardiac arrest to establish any pattern and its relationship to the subsequent deterioration of patients. Methods: A retrospective case note review was conducted of all cardiac arrests in the study hospital occurring over a 6-month period. Results: The majority of cardiac arrests occurred out of hours (69.7%). Of the nurses recording the final MEWS preceding cardiac arrest, 13 (39.9%) were registered nurses and 20 (60.6%) were healthcare assistants. The majority of MEWS recorded immediately preceding cardiac arrest were 1 (15; 45%); the mean MEWS was 2.24, the median was 2 and the mode was 1. Conclusion: This retrospective case note review has examined the use and characteristics of the MEWS on the medical wards of one district general hospital in the 24 hours preceding cardiac arrest. Key issues have been identified regarding MEWS at the point of cardiac arrest, and the use of the referral pathway by healthcare professionals. Communication of deterioration is imperative to the management of deterioration on the general wards.