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    Modified Early Warning Score (MEWS) for Clinical Deterioration

    Determines the degree of illness of a patient.
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    INSTRUCTIONS

    Different institutions and regions may use different modifications of the MEWS. Verify that your institution uses the same points assignments listed here.

    When to Use
    Pearls/Pitfalls
    Why Use

    The MEWS can be used on all hospitalized patients to allow for the early detection of clinical deterioration and potential need for higher level of care.

    • The Modified Early Warning System (MEWS) is a tool designed to identify patients with declining conditions.
    • It has been shown to be superior to clinical judgement for this purpose.
    • It was originally designed for nurses but can be used by any healthcare professional with adequate training.
    • MEWS is based on the principle that clinical deterioration can be seen through subtle changes in a number of parameters as well as large changes within a single variable.
    • The scale is calibrated to different populations and sometimes expanded to include additional parameters.
    • While a score of 5 or more has been shown to be associated with a higher likelihood of admission to an intensive care unit or death, this threshold can be modified to accommodate different patient populations or clinical settings.
    • The National Early Warning Score (NEWS) 2 was developed and updated by the Royal College of Physicians in the UK to standardize the identification and response to deteriorating patients.
    • Patients with low MEWS can continue receiving their usual care and observation.
    • Patients with high MEWS should be watched more attentively and considered for transfer to a higher care unit such as an ICU.
    ≤70 mmHg
    +3
    71-80 mmHg
    +2
    81-100 mmHg
    +1
    101-199 mmHg
    0
    ≥200 mmHg
    +2
    <40 bpm
    +2
    41-50 bpm
    +1
    51-100 bpm
    0
    101-110 bpm
    +1
    111-129 bpm
    +2
    ≥130 bpm
    +3
    <9 bpm
    +2
    9-14 bpm
    0
    15-20 bpm
    +1
    21-29 bpm
    +2
    ≥30 bpm
    +3
    <35°C / 95°F
    +2
    35–38.4°C / 95–101.1°F
    0
    ≥38.5°C / 101.3°F
    +2
    Alert
    0
    Reacts to voice
    +1
    Reacts to pain
    +2
    Unresponsive
    +3

    Result:

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    Next Steps
    Evidence
    Creator Insights

    Management

    Once the MEWS identifies a patient at risk of deterioration, the medical team will need to identify the cause and address it accordingly.

    Critical Actions

    • This score can be used by any healthcare worker with proper training in how to use it and interpret the results.
    • It is meant to be used on a regular basis rather than once on admission.
    Content Contributors
    About the Creator
    Dr. Christian Peter Subbe
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