title: A national cross sectional survey of heads of midwifery services of uptake, benefits and barriers to use of obstetric early warning systems (EWS) by midwives.
abstract: OBJECTIVE
  to identify the extent to which Early Warning Systems (EWS) are used by midwives in the United Kingdom (UK), the maternity settings they are used in, physiological parameters used to 'trigger' referral, training provision, barriers to implementation and role in preventing maternal morbidity.
  
  
  METHODS
  cross-sectional survey of heads of midwifery services. An email questionnaire was sent in September 2012.
  
  
  METHODS
  UK NHS secondary care organisations providing maternity care.
  
  
  RESULTS
  heads of midwifery from 107 (68%) of 157 NHS organisations responded, with 108 questionnaires returned as two organisations had recently merged. All organisations, apart from one which only had a free-standing midwifery unit, had introduced EWS. Nearly all respondents (99%) reported EWS were used by midwives antenatally, 76% in labour and 100% on the postnatal ward. All EWS charts included body temperature, heart rate, respiratory rate, systolic blood pressure and oxygen saturation although parameters for escalation varied widely. Barriers to use of EWS by midwives included overlap with the partogram in labour, and staff shortages and delays obtaining clinical review when referral was triggered. Two-thirds considered EWS prevented maternal morbidity although few could provide supporting evidence, for example, audit findings. Training for midwives in use of EWS was available in 83% of organisations.
  
  
  CONCLUSIONS
  most UK midwives are using EWS, with the highest use in obstetric units. The heterogeneity of EWS currently used potentially limits collation of evidence to inform appropriate system level responses. Research is needed to evaluate the role of EWS to prevent maternal morbidity during and after pregnancy in different maternity settings.
authors.affiliation: King׳s College London, Florence Nightingale School of Nursing and Midwifery, London, UK. Electronic address: debra.bick@kcl.ac.uk.
authors.forename: Debra E
authors.initials: DE
authors.lastname: Bick
authors.affiliation: King׳s College London, Division of Women׳s Health, King׳s College London, London, UK.
authors.forename: Jane
authors.initials: J
authors.lastname: Sandall
authors.affiliation: Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Shogoin Kawara-cho, Sakyo-ku, Kyoto City, Kyoto 606-8507, Japan.
authors.forename: Marie
authors.initials: M
authors.lastname: Furuta
authors.affiliation: Poole Hospital NHS Foundation Trust, Poole, UK.
authors.forename: Michael Y K
authors.initials: MY
authors.lastname: Wee
authors.affiliation: University Hospital Southampton NHS Foundation Trust, Southampton, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Isaacs
authors.affiliation: Centre of Postgraduate Medical Research & Education, Bournemouth University, Bournemouth, UK.
authors.forename: Gary B
authors.initials: GB
authors.lastname: Smith
authors.affiliation: King׳s College London, Florence Nightingale School of Nursing and Midwifery, London, UK.
authors.forename: Sarah
authors.initials: S
authors.lastname: Beake
mesh_terms: D003430:Cross-Sectional Studies; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D008880:Midwifery / Q000379:methods*; D011247:Pregnancy; D011795:Surveys and Questionnaires; D006113:United Kingdom
keywords: Adverse events; Maternal morbidity; Midwifery; Obstetric Early Warning Systems; Patient safety