1. Annual Nursing Research & Evidenced Based Practice Symposium Decreasing Preventable Codes September 10, 2009 By Minnie Gaffney RN, CCRN The Rapid Response Team and MEWS

2. The Rapid Response Team and MEWS Background Initiated at NMH, January 2006 Nurse lead, dedicated team Proactive Wanted to impact patient care

3. Choices APACHE II – ER/ICU population – Lengthy – Not all information available for general population – Labor intensive for primary floor nurses MEWS – Easy short form for hand calculations – All information easily available – Readily accepted by RNs and PCTs who assisted with trial

4. Modified Early Warning Score 3210123 Systolic Blood pressure (mmHg) <7071-8081-100101-199≥200 Heart Rate (bpm) <4041-5051-100101-110111-129≥130 Respiratory rate (bpm) <99-1415-2021-29≥30 Temperature (°C) <3535-38.4≥38.5 AVPU score AlertReacting to Voice Reacting to Pain Unresponsive

5. MEWS (Modified Early Warning Score) 3210123Total Temp <36°C <96.8°F 36-38°C 96.8-100.4°F >38° >100.4° HR (bpm) <4141-5051-100101-110111-129>129 RR (bpm) <1010-2021-2425-28>28 SpO2 <91%91-94%95-100% SBP (mmHg) <8181-9091-100101-160161-170171-180>180 CAM +- Resp Assessment +-

6. Rapid Response Team goes Electronic An electronic MEWS scoring patients based on vital sign data entered into PowerChart, was developed to assist RRT RNs in their proactive identification of at-risk patients.

7. Rapid Response Team: Results An observed reduction in average number of preventable codes per 1000 patient days has been achieved since the implementation of the electronic MEWS; and on average an additional 250 patients are seen by the RRT RN each month. To date 15,870 patients have been seen by RRT.

8. Rapid Response Team: Results An observed reduction in average number of preventable codes per 1000 patient days has been achieved since the implementation of the electronic MEWS; and on average an additional 250 patients are seen by the RRT RN each month. To date 15,870 patients have been seen by RRT.

9. Thank You! Pat Murphy, RN, MSN, MBA Kristin Ramsey RN, MSN, MPPM, NE-BC All of my Rapid Response Team colleagues, awesome nurses!