Rapid Response Team and MEWS

[nytenurse2]

Nurses within my facility use the Modified Early Warning System (MEWS) to avert further decline in patient conditions. The system has increased calls to the rapid response team (RRT), reduced the "code blue" incidences, and contributed to a significant reduction in mortality.

While we have made leaps and bounds in the right direction, the MEWS scoring system does not take into consideration the baseline condition (i.e. vital signs, etc.) of the patient. The system has also taken away from the clinical judgment of the floor nurse. For example a 95 y/o patient admitted with unresponsiveness and hypernatremia scored a 3 in the emergency department and a 4 upon arrival to the floor. The score of 4 deployed the RRT only minutes after the patient arrived to the floor. Another example, a MEWS score initiated the RRT in a case where the patient was tachycardic related to a fever that she had upon admission. She already had orders for blood cultures, fluids, Tylenol, antibiotics, etc.

My questions: (1) are you aware of the MEWS being used in palliative/comfort care patients, (2) how is the MEWS used in patients with DNR status, (3) how is the patient's baseline condition taken into consideration?

We have ICU nurses being pulled from the sickest patients in the hospital to respond to MEWS scores that are unchanged from the baseline, floor nurses are in fear of being written up if they do not request the RRT , physicians are being told they cannot write an order to override the MEWS score, and clinical judgment is being overlooked.

Any input would be appreciated. Thank you.