Evaluating Effectiveness of MEOWS Tool in Identifying Maternal Deterioration in Women Receiving Care among Nurses in Maternity Unit, at General Hospital, Dammam

Nicolette Abraham; Nor Aroma Abu Bakar; Atikah Al Aaly; Alaa Moustafa; Mohammad Nasir Abdul Kudus

doi:10.55265/lpssjournal.v2i2.41

Authors

Nicolette Abraham Imam Abdulrahman Al Faisal Hospital, 954G+VRQ, King Saud Bin Abdulaziz Rd, Al Haras Al Watani, Dhahran 34232, Saudi Arabia
Nor Aroma Abu Bakar Imam Abdulrahman Al Faisal Hospital, 954G+VRQ, King Saud Bin Abdulaziz Rd, Al Haras Al Watani, Dhahran 34232, Saudi Arabia
Atikah Al Aaly Imam Abdulrahman Al Faisal Hospital, 954G+VRQ, King Saud Bin Abdulaziz Rd, Al Haras Al Watani, Dhahran 34232, Saudi Arabia
Alaa Moustafa Imam Abdulrahman Al Faisal Hospital, 954G+VRQ, King Saud Bin Abdulaziz Rd, Al Haras Al Watani, Dhahran 34232, Saudi Arabia
Mohammad Nasir Abdul Kudus Imam Abdulrahman Al Faisal Hospital, 954G+VRQ, King Saud Bin Abdulaziz Rd, Al Haras Al Watani, Dhahran 34232, Saudi Arabia

DOI:

https://doi.org/10.55265/lpssjournal.v2i2.41

Keywords:

MEOWS tool, maternal deterioration, maternity unit

Abstract

Pregnant women are at risk of obstetric emergencies at all stages of life, including before, during, and after delivery. The lack of tools to help signal healthcare providers to initiate treatment can impact caregivers who cannot rely entirely on clinical judgment. Therefore, to avoid poor maternal outcomes due to delays or errors in maternal management, it is important that all midwifery staff understand the 'early warning signs' and are able to assess the clinical status of the mother using the MEOWS tool. This quantitative design study of the action research type using a cross-sectional method was conducted from October 2017 to July 2020 at the Maternity Unit, NGHA Dammam. The main objective of this study is to evaluate the effectiveness of implementing maternal early warning signs to identify maternal deterioration and reduce maternal transfer to the Intensive Care Unit (ICU). The data collected is related to the number of mothers transferred to the ICU in the absence of educational training related to the MEOWS tool in the health care system from October 2017 until October 2018. Data related to the number of mothers transferred to the ICU due to deterioration was collected and compared with the data on the number of mothers admitted to the ICU after the MEOWS tool was fully implemented in June 2019 until July 2020. A total of thirty-three (N = 33) nurses participated in this survey and passed tests related to maternal warning signs. There are more than three quarters of them showing good knowledge about early warning signs of mothers with a mean score of 1.98 (SD = 0.402), reaching a mean score of 1.99 (SD = 0.179), which reflects a good attitude towards the practice (mean score = 2.00; SD =0.000). However, the results showed that none of the tested variables, including age, highest qualification, marital status, and years of work experience, had a significant relationship with their level of knowledge in identifying maternal impairment using MEOWS. The statistics of the mother's transfer to the ICU were also found to decrease compared to before the implementation of MEOWS in the system. This study suggests that MEOWS should be practiced among nurses in the maternity unit, improving the midwifery syllabus and continuing nurses' competence related to MEOWS practice.

References

Alias, A.L., & Mohamed Ludin, S. (2021). Knowledge, attitudes and practice of nurses in assessing patients using early warning sign (EWS) scoring in a teaching hospital in Kuantan Pahang, Malaysia. International Journal of Care Scholars, 4(1), 48-57.

Badr, M.N., Khalil, N.S., & Mukhtar, A.M. (2021). Effect of the national early warning score education program on nurses' knowledge at an emergency hospital. Medico-Legal Update, 21(4), 260-268. doi: 10.37506/mlu.v21i4.3140.

Caroline S. Langkjaer, Karin Bundgaard, Gitte Bunkenborg, Pernille B. Nielsen, Kasper K. Iversen, Morten H. Bestle, Dorthe G.

Bove. (2023). How nurses use National Early Warning Score and Individual Early Warning Score to support their patient risk assessment practice: A fieldwork study. Journal Advance Nursing, 79, 789–797.

Chandran, A., Gnanarani, J., & Venkatesan L. (2018). Effectiveness of competency training program on Modified Early Warning

System (MEWS) upon the knowledge of nurses in selected hospitals, Chennai. Asian Pacific Journal of Nursing and Health Sciences, 1(1), 16-9. doi: 10.46811/apjnh/1.1.5.

Donilon, D. M. (2013). Nurses Perceptions of their Competence in Managing Patient Situations in acute care. [Doctoral dissertation, University of Rhode Island]. https://doi.org/10.23860/diss-donilon-donna-2013

Friedman, A.M. (2015). Maternal early warning systems. Obstetrics and Gynecology Clinics of North America, 42(2), 289–298. https://doi.org/10.1016/j.ogc.2015.01.006

Friedman, A.M., Campbell, M.L., Kline, C.R., Wiesner, S., D’Alton, M.E., & Shields, L.E. (2018). Implementing obstetric early warning systems. Am Journal Perinatology Reproductive, 8, 79-84. https://doi.org/10.1055/s-0038-1641569.

Hwang, J.I., & Kim, S.W. (2021). Using an Early Warning Score for Nurse Shift Patient Handover: Before-and-after study. Asian Nursing Journal, 16 (1), 18-24. https://doi.org/10.1016/j.anr.2021.12.005

Iba´ñez-Lorente, C., Casans-France´s, R., Bellas-Cota´n, S., & Muñoz-Alameda, L.E. (2021). Implementation of a Maternal Early

Warning System during Early Postpartum. A prospective observational study. PLoS ONE, 16 (6) e0252446. https://doi.org/10.1371/journal.pone.0252446

Jensen, J. K., Skår, R., & Tveit, B. (2019). Introducing the National Early Warning Score: A qualitative study of Hospital Nurses’ Perceptions and Reactions. Nursing Open, 6 (3), 1067-1075. https://doi.org/10.1002/nop2.291

Khergade, M., Suri, J., Bharti, R., Pandey, D., Bachani, S., & Mittal, P. (2020). Obstetric Early Warning Score for Prognostication of Critically Ill Obstetric Patient. Indian Journal Critical Care Medicine, 24 (6), 398–40.

Ludin, S. M. (2018). Risk of Deterioration among general ward patients: Nurses' ability in assessing early warning signs. Malaysia Journal of Medical Research, 2 (1), 19-29.

Matt, I. K., & Emmanuel, N. (2018). NEWS: an opportunity to standardize the management of deterioration and sepsis. BMJ, 360, k1260.

Moore, D.M. (2023). Maternal-Early-Warning-System education to improve registered nurse knowledge of and appropriate responses to triggers. [Doctoral dissertation, Walden University].

Nair, Dockrell & Colgain (2018). Maternal Early Warning Scores (MEWS). Obstetric Anesthesia, 383, 1-5.

National Health Services. (2020). National Early Warning Score (NEWS): Standardizing the assessment of acute illness severity in the NHS. Additional Implementation Guidance March 2020, United Kingdom.

Norfolk and Norwich University Hospital MEOWS Guidelines. (2022). MEOWS. www.nnuh.nhs.uk.

Paternina-Caicedo, A., Miranda, J., Bourjeily, G., & et al. (2017). Performance of the Obstetric Early Warning Score in critically ill patients for the prediction of maternal death. Am Journal Obstetric Gynecology, 216, 58, 1-8.

Samani, S., & Rattani, S.A. (2023). Recognizing Early Warning Signs (EWS) in patients is critically important. Open Journal of Nursing, 13, 53-64. https://doi.org/10.4236/ojn.2023.131004

Singh, S., McGlennan, A., England, A., & Simons, R. A. (2012). Validation study of the CEMACH recommended modified early obstetric warning system (MEOWS). Anesthesia, 67, 12–18.

Suphatrakul, W., Donlao, K., & Mahawan, P. (2020). Effect of using NEWS score to surveillance for variations change and warning signs for patients at emergency room Nakornping Hospital, Chiangmai Province. Journal of Nakornping Hospital, 11 (1), 45-59.

Umar, A., Ameh, C.A., Muriithi, F., & Mathai, M. (2019). Early warning systems in obstetrics: A systematic literature review. PloS One, 14(5), e0217864.

Xu, Y., Zhu, S., Song, H., Lian, H., Zeng, M., He, J., & et al. (2022). A new Modified Obstetric Early Warning Score for prognostication of severe maternal morbidity. BMC Pregnancy and Childbirth, 22, 901. https://doi.org/10.1186/s12884-022-05216-7