Monitoring vital signs: development of a modified early warning scoring (MEWS) system for general wards in a developing country.
OBJECTIVE
The aim of the study was to develop and validate, by consensus, the construct and content of an observations chart for nurses incorporating a modified early warning scoring (MEWS) system for physiological parameters to be used for bedside monitoring on general wards in a public hospital in South Africa.


METHODS
Delphi and modified face-to-face nominal group consensus methods were used to develop and validate a prototype observations chart that incorporated an existing UK MEWS. This informed the development of the Cape Town ward MEWS chart.


METHODS
One specialist anaesthesiologist, one emergency medicine specialist, two critical care nurses and eight senior ward nurses with expertise in bedside monitoring (N = 12) were purposively sampled for consensus development of the MEWS. One general surgeon declined and one neurosurgeon replaced the emergency medicine specialist in the final round.


RESULTS
Five consensus rounds achieved ≥70% agreement for cut points in five of seven physiological parameters respiratory and heart rates, systolic BP, temperature and urine output. For conscious level and oxygen saturation a relaxed rule of <70% agreement was applied. A reporting algorithm was established and incorporated in the MEWS chart representing decision rules determining the degree of urgency. Parameters and cut points differed from those in MEWS used in developed countries.


CONCLUSIONS
A MEWS for developing countries should record at least seven parameters. Experts from developing countries are best placed to stipulate cut points in physiological parameters. Further research is needed to explore the ability of the MEWS chart to identify physiological and clinical deterioration.
Division of Nursing and Midwifery, Department of Health & Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, South Africa.
Una
U
Kyriacos
Department of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, South Africa.
Jennifer
J
Jelsma
Department of Anaesthesiology, Groote Schuur Hospital/University of Cape Town, South Africa.
Michael
M
James
School of Human and Health Sciences, Swansea University, Wales, United Kingdom.
Sue
S
Jordan
D032921:Consensus; D003422:Critical Care / Q000458:organization & administration*; D006801:Humans; D008991:Monitoring, Physiologic / Q000379:methods*; D010362:Patients' Rooms; D017410:Practice Guidelines as Topic; D013019:South Africa; D055986:Vital Signs