EBN Journal Chat – Managing patient deterioriation – 05/02/14, 8-9pm

Deterioration in acutely unwell patients can occur rapidly and have detrimental effects, therefore it is important to observe, identify and act to improve patient outcomes. In observing the patient you would be expected to monitor and record the following, blood pressure, heart rate, respiration with oxygen saturation, temperature, urine output, fluid intake (accurate fluid balance) and blood glucose level. Ideally do a Glasgow Comma Scale, it is often a sign of deterioration. If deterioration is mismanaged it can lead to poorer patient outcomes (Baudouin and Evans 2002). To aid identifying patients at risk of deterioration nurses can use the Modified Early Warning Score (MEWS) (Subbe, Kruger, Gemmel 2001) based on physiological parameters, which are taken when recording patient observations. The observations taken are incorporated in this scoring system. An aggregated score is then calculated from all parameters, if the identified threshold score is reached, an escalation pathway is activated. The escalation pathway outlines actions required for timely review ensuring appropriate interventions for patients. This often includes informing the doctor and contacting the outreach nurses.

This Twitter chat aims to discuss the following:

  1. How do you identify a deteriorating patient
  2. Why are observations important
  3. What actions can be taken to improve outcome
  4. How can outreach nurses assist ward nurses 
  5. Your experiences of caring for a deteriorating patient
Score 3 2 1 0 1 2 3
Systolic BP <45% 30% 15% down Normal for patient 15% up 30% >45%
Heart rate (BPM) <40 41-50 51-100 101-110 111-129 >130
Respiratory rate (RPM) <9 9-14 15-20 21-29 >30
Temperature (°C) <35 35.0-38.4 >38.5

Example of a MEWS score system


Baudouin S, Evans T 2002 Improving outcomes for severely ill medical patients Clin Med. Mar-Apr; 2(2):92-4

Buykx P, Kinsman L, Cooper S, et al. 2011 FIRST2ACT: educating nurses to identify patient deterioration – a theory-based model for best practice simulation education. Nurse Educ Today. (7):687-93.

Subbe C.P., Kruger M., Gemmel L. – “Validation of a modified Early Warning Score in medical admissions.” Quarterly Journal of Medicine 2001; 94; 521-6

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