Student Dissertation

Agency : Modified early warning score; MEWS; MEWS training; MEWS calculation

Objective : The objective of the study was to: • Assess the knowledge of In-house doctors on MEW Score calculation. • Observe the effect of training on MEW Score calculation of In- house doctors.

Background : Modified Early Warning Score (MEWS)also known as bedside score and track-and-trigger systems. Nurses score observations of vital signs and calculate a total score to facilitate early recognition of a patient’s deterioration. MEWS systems are used in conjunction with nurses’ clinical judgment”. Aberrant physiology is common among Vulnerable patients in wards, clinical and physiological deterioration is evident for six to eight hours before the cardiopulmonary arrest. In such cases, the arrest often occurs after a period of slow and progressive physiological deterioration that went unrecognized and/or inadequately treated hypoxemia and hypotension”. Non-recognition of deterioration in clinical status has implications for patient survival, which depends on nurses’ decisions to summon assistance. Clinical signs such as skin tone, sweating, nausea or nurses’ intuitive assessment of the patient being ‘just not right’ and ‘looking unwell ‘should be monitored regularly to limit avoidable, serious adverse events (SAEs) such as cardiac arrest, urgent and unanticipated admission to an intensive care unit (ICU) or even death. In addition to obvious ethical considerations, authorities in the developed world are concerned at the increasing number of claims for malpractice associated with SAEs”

Methodology : Methodology: Study Design: Operational research study (analytical study) was conducted with the help of a structured case scenario. The structured scenarios were used both in pre and post-training the duration for this study was for 3 months (Feb 2018 to April 2018) Sampling: In this study, purposive sampling was considered. Inclusion criteria: MBBS, DNB 1st year and MD 1st year. Total of 97 in-house doctors was in inclusion criteria hence taken as the study population. Data collection and analysis: A set of well defined-structured schedule with close-ended questions was developed. The schedule was focused on Healthcare provider’s basic information and Case scenarios for calculation on the Modified Early Warning Score, it was circulated among doctors before and after training. The raw data was entered and analyzed from the Microsoft Office Excel spreadsheet and also IBM SPSS Statistics 16 was used.

Findings : In our study respondents had no prior knowledge on calculating MEW Score but they were aware MEWS actions and their responses were based on knowledge gained from clinical placement experiences. 5 case scenarios were considered as questions, it was taken to measure the knowledge of MEWS from above table, question 1 to question 4, correct pre-test score is 24% and after training the correct post-test score is 96.5% but in case of question 5 a special case scenario was given and raise in scores from 4% to 20%. Paired samples t-test was used to analyze the effectiveness of training. There was significant effect in the scores of post-test (Mean=4, SD=0.651) and pre-test (Mean =1, SD = 1.082) conditions; t(96 ) = 22.72, p = 0.000. These results suggest that training really does have an effect on MEW Score calculation among in-house doctors at Fortis Hospital, Bengaluru and hence we reject the null hypothesis and conclude that there is an effect after the training and making training effective.

Recommendations : The overall post-training knowledge among in-house doctors at Fortis Hospital, Bangalore was improved as shown in results. Majority of the doctors have satisfactory knowledge on action taken on MEW Score and MEW Score calculation. Further research is needed to explore the ability among doctors in calculating MEWS and its action to identify physiological and clinical deterioration.

Research Questions: What is the knowledge level on MEW Score calculation among in-house doctors? What is the effect of training on MEW Score calculation among in-house doctors?