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Early Warning Score Modified Early Warning Score Modified Obstetric Early Warning Score

Early Warning Score Modified Early Warning Score Modified Obstetric Early Warning Score. Harry Gee MD, FRCOG. What Are They?. Monitor Vital Signs Identify the key ones Policy on performance Chart & Colour Code Give Scores According to Deviation Aggregate Score Guidelines Action

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Early Warning Score Modified Early Warning Score Modified Obstetric Early Warning Score

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  1. Early Warning ScoreModified Early Warning ScoreModified Obstetric Early Warning Score Harry Gee MD, FRCOG

  2. What Are They? • Monitor Vital Signs • Identify the key ones • Policy on performance • Chart & Colour Code • Give Scores According to Deviation • Aggregate Score • Guidelines • Action • Involvement of Expertise & Team Working • Implementation • Auditing

  3. From:Ann R Coll Surg Engl. 2006 October; 88(6): 571-575. Comparison between the group of patients who triggered the call-out algorithm with the group that did not MEWS < 4 MEWS ≥ 4 Significance Age (years mean ± SD) 57 ± 19.4 66 ± 16.7 P < 0.01 Gender ratio (M:F) 140:136 25:33 Chi-square N/S Percentage that were emergency admissions 59% 82% Chi-square P < 0.001 ASA grade (median and range) 2 (1−4) 2 (1−4) Not applicable Diagnosis of bowel obstruction 5.8% 23.6% Chi-square P < 0.001 Diagnosis of malignancy 12.6% 38.2% Chi-square P < 0.001 Death 0% 7.2% Chi-square P < 0.001 Length of hospital stay 3 (1−41) 10 (2−41) Mann-Whitney U-test (median and range) P < 0.05

  4. Frequency of EWS observations LSCS 1⁄2 hourly for four hours Hourly for six hours Four hourly for 48 Daily until discharge Other procedures under anaesthesia 1⁄2 hourly for four hours Hourly for six hours Four hourly for 24 hours Postpartum haemorrhage 1⁄2 hourly for four hour Four hourly for 24 hours Prophylactic syntocinon Four hourly for 24 hours Diastolic of 90 or over Minimum four hourly NB Women with diastolic of 110 or over and/or MAP of 125 or above should commence on the PIH protocol

  5. Frequency of EWS observations Antenatal in patients Four hourly (diabetics, ruptured membranes, known or suspected infection) Postnatal women with suspected or confirmed infection Four hourly for a minimum of 24 hours Once daily until discharge Medical management of miscarriage Hourly from start of treatment until discharge Blood transfusion Prior to start of transfusion 15 minutes into transfusion Post transfusion (Must be done for each unit of blood transfused)

  6. HDU - Suggested Equipment • Monitor for P, BP, ECG, SaO2 • Equipment for insertion and management of invasive monitoring (arterial and CVP) • Piped oxygen and suction • Intravenous fluid warmer • Forced air warming device • Blood gas analyser* • Infusion pumps • Emergency massive haemorrhage trolley* • Emergency eclampsia box* • Transfer equipment - monitor and ventilator • Computer terminal to facilitate access to blood results , PACS system • Copy of hospital obstetric guidelines (if not available on hospital intranet) • Resuscitation trolley with defibrillator and airway management equipment

  7. African Early Warning Score Professor Andrew Weeks, Liverpool University, UK

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