1. Early warning signs Save lives Prepared by Ibrahim Shaheen

2. Introduction Early warning score system use multiple-parameter or aggregate weighted scoring systems, which allow a graded response. These scoring system: A.Define the parameters to be measured and the frequency of observations. B.Include a clear and explicit statement of the parameters, cut-off points or scores that should trigger a response. 1.The scoring system of early warning signs shall be performed by competent nurses and physicians. 2.Patients and their families shall be educated about the early warning signs system used. 3.The scoring system is to all non-critical care units.

3. Purpose A.To improve the process of patient observation and monitoring. B.To improve communication within the multidisciplinary team with regards to changes in patient health care status. C. To ensure timely intervention for those patient who are worsening. D. To support timely medical and nursing decisions. E. To provide clear guidance and instruction to health care provider with regard to the use of the Early Warning Signs & their Escalation Protocols. F. To ensure patient/family education about the patient condition

4. MAIN TYPES 1.The Modified Early Warning Score (MEWS) is used for adult patient’s > 12 years. 2.The Pediatric Early Warning Score (PEWS) is used for patients aged 12 and below. 3. The Modified Early Obstetric Warning Score (MEOWS) is used for pregnant women until 6 weeks POST NATAL

5. MEWS The Modified Early Warning Score (MEWS): Is a standardized risk assessment tool to identify patients showing signs and symptoms of clinical instability before their conditions deteriorates. This tool is based on physiological indicators routine observations and detects changes in a patient’s physiology, which will be reflected in a change of score should the patient be improving or deteriorating. The higher the score the more intervention and support required. This MEWs is used for patient above 12 years.

6. MEOWS The Modified Early Obstetrics Warning Score (MEOWS ): Is a standardized risk assessment tool to identify obstetric patients showing signs and symptoms of clinical instability before their conditions deteriorates. This tool is based on physiological indicators routine observations and detects changes in a patient’s physiology, which will be reflected in a change of score should the patient be improving or deteriorating. The higher the score the more intervention and support required. MEOWs is used for obstetrics patients.

7. MEOWS CASES 1.The Modified Early Obstetric Warning Score (MEOWS) is used for pregnant women until 6 weeks postnatal. MEOWS cases may include: A.All women whose clinical condition requires close observation; admitted early pregnancy, antenatal or postnatal. B.All post-operative cases in recovery and following transfer from theatre. C.Any woman giving cause for concern (medical or obstetric causes). D.During/Following APH/PPH/Eclampsia. E.Suspected infection e.g. Prolonged SROM. F.High-risk women in delivery suite (not in labor).

8. MEOWS ESCCALATION PROTOCOL

9. MEOWS SCORE

10. PEWS The Pediatric Early Warning Score (PEWS): An Early Warning Score is a set of simple algorithms relating to the findings of physiological parameters. These parameters are given numbers depending on the range of severity within which they fall into, the total number added at the end of the observations taken is the score given. PEWs is used for patients aged 12 years and below

11. PEWS SCORING SYSTEM

12. Pediatrics normal vital signs