Evaluation of the Modified Early Warning Score (MEWS) Screening Tool for Physiological Signs of Sepsis and the Burden on Emergency Department Registered Nursing Staff Public Deposited

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  • March 20, 2019
Creator
  • Phillips, Cameron
    • Affiliation: School of Nursing
Abstract
  • Sepsis is the leading cause of death in hospitals worldwide and one of the most expensive reasons for hospitalization in the US. The CDC reported that sepsis begins outside of the hospital in approximately 80% of cases, and most septic patients first seek treatment at the emergency department (ED) where prompt recognition could decrease mortality. Screening tools used on inpatient hospital units utilize vital signs and laboratory data, however use is limited in the ED. To promote rapid, cost-effective screening for sepsis, the Modified Early Warning Score (MEWS) was implemented to screen adults for abnormal temperature, heart rate, blood pressure, respiratory rate, subjective decreased urine output and altered mental status. There is a lack of research evaluating the ability of the MEWS or any other tool to screen for physiological signs of sepsis in the ED. A retrospective chart review evaluated the accuracy and reliability of the MEWS screen. Two hundred cases were collected; 100 identified as having a positive MEWS and documented suspicion of infection, and 100 identified as having a negative MEWS and no suspicion of infection. A true positive case definition of having an ICD-10 inpatient discharge diagnosis of sepsis was set prior. The data was evaluated using a 2x2 table for sensitivity, specificity and predictive value. A survey was sent to 125 ED nurses to assess perceptions of the MEWS. Quantitative analysis was performed to estimate the number of manual MEWS’s done over a twelve-hour shift. Results showed 53 true-positive cases, 47 false-positive cases, 6 false-negative cases and 94 true-negative cases. The MEWS tool showed 89.83% sensitivity and 66.67% specificity at identifying physiological signs of sepsis. It showed a positive-predicative-value of 53% and a negative-predictive-value of 94%. False-positive cases were predominately associated with respiratory, skin and urinary infections. ED nurses supported the MEWS, but consensus was mixed on who should be screened and how often. A positive MEWS with clinical suspicion for infection expedites throughput for patients with sepsis, leading to faster evaluation, decreased time to confirmed diagnosis, and timely implementation of lifesaving treatment to improve patient outcomes despite its direct burden on nursing staff.
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  • In Copyright
Advisor
  • Seely, Brian
  • Davison, Jean
  • Travers, Debbie
Degree
  • Doctor of Nursing Practice
Degree granting institution
  • University of North Carolina at Chapel Hill Graduate School
Graduation year
  • 2017
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