Maternal Early Warning System
The Maternal Early Warning System (MEWS) initiative seeks to implement a protocol into practice to facilitate timely recognition, diagnosis, and treatment for pregnant women developing critical illness, thus avoiding major morbidity and mortality. Essential components of an early warning system include: 1) maternal early warning criteria that prompts reporting to a clinician; and 2) an effective escalation process that prompts bedside evaluation by a clinician.
Maternal death in the United States is “just the tip of the iceberg.” For every maternal death, 100 women experience severe maternal morbidity (SMM). SMM refers to unexpected outcomes of the process of labor and delivery that result in significant short- and long-term consequences to a woman’s health. According to a recent report, SMM prevalence was 19.7 per 1,000 deliveries in Texas in 2015. A substantial proportion of SMM is potentially preventable and, thus, can be targeted as a means of preventing maternal mortality.
For every maternal death, 100 women experience severe maternal morbidity.
The learning collaborative is working on implementing a MEWS protocol to increase the early recognition of changes in a mother’s vital signs and clinical conditions leading to effective escalation and prompt evaluation with the goal of reducing the number of women experiencing obstetrical hemorrhage, hypertension, or other severe maternal morbidities. The TCHMB MEWS collaborative is a component of TexasAIM, which is coordinated by the Texas Department of State Health Services (TDSHS). TCHMB provides MEWS technical assistance to hospitals implementing TexasAIM, which will strengthen the readiness and recognition components of the maternal safety bundles.
Elements of the MEWS Protocol
Hospitals can choose to implement a MEWS protocol that works best in their setting. Below are two examples:
Single Trigger: The National Partnership for Maternal Safety defines a single trigger criteria as any one in a list of abnormal parameters that indicate the need for urgent bedside evaluation by a clinician with the capacity to escalate care as necessary in order to pursue diagnostic and therapeutic interventions. Evaluation and management are at the discretion of bedside provider.
Pathway-Specific Triggers are 1 or 2 abnormal values with recommended clinical evaluation and treatment guidelines. They allow for the initiation of diagnostic and therapeutic options by bedside nurse.
Divya Patel, PhD, UT Health Science Center at Tyler, Affiliate of The University of Texas System
Amanda Wagner, MSN, WHNP-BC, UT Health Science Center at Tyler, Affiliate of The University of Texas System
Maternal Early Warning Signs (MEWS): National Council on Patient Safety
Downloadable PDF of Maternal Early Warning Signs (MEWS) Protocol
Maternal Early Warning Trigger (MEWT) Tool: Washington State Hospital Association
Maternity Watch Program
MEWT Screening Tool
MEWT Escalation Plan in Rural hospital - Example A
MEWT Escalation Plan in Tertiary hospital - Example B
Shields 2016 AJOG (Use of MEWT reduces maternal morbidity)
Modified Early Obstetric Warning System (MEOWS): International study
Singh 2012 Anesthesia (A validation study of the CEMACH recommended MEOWS)