Modified Early Warning Score

Don’t you ever just wish that there are some signs that may clue you in on what’s going to happen in the future? Or in some cases, do you just wish there are those cues that may tell you about the things happening in the present? Like some sort of warning to signal us on what to expect and what to do.

Well, we actually have that in nursing: a score board to tip us on a patient’s present condition, whether they need to be hospitalized or may require intensive care. Introducing MEWS or Modified Early Warning Score.


Digging deeper into MEWS

It was first introduced in 2001 as the Early Warning score but later on was called Modified Early Warning Signs.  It serves as a tool for nurses to help monitor their patients and improve how quickly a patient experiencing a sudden decline receives clinical care. The score you get from MEWS is based upon common vital signs such as Temperature, Respiratory rate, Heart rate and Systolic blood pressure; as well as nursing assessments of mental status or consciousness level of the patient, hourly urine output (for the previous 2 hours) and/or age/BMI.

It is greatly beneficial especially in emergency cases wherein the nurse and other members of the health team need to quickly determine the degree of illness of a patient. In other wards, it is also helpful in identifying medical patients at risk of catastrophic deterioration in a busy clinical are.

Basically, a normal vital sign is scored a zero and above; a below normal is scored a 1 or 2 based upon how far from normal they are. Then, these scores are summed up and recorded by the nurse every time a patient’s vital signs are checked.

A score of five or more is statistically linked to increased likelihood of death or admission to an intensive care unit.

At present, different MEWS systems are used in health institutions worldwide, however the parameters may vary or in other cases, weighting of the scores for worsening deterioration are changed since some systems also assign scores to other parameters including urine output, oxygen saturation, flow rate of oxygen administration and pain scores.

One very important thing to remember when using MEWS is that it is not specific to sepsis, rather an indicator of general instability or the level of illness for the patient. And since the primary purpose of MEWS is to prevent delay in intervention or transfer of critically ill patients, it also provides space for improvement in the quality and safety of management provided to patients.





Liane Clores, RN MAN

Currently an Intensive Care Unit nurse, pursuing a degree in Master of Arts in Nursing Major in Nursing Service Administration. Has been a contributor of Student Nurses Quarterly, Vox Populi, The Hillside Echo and the Voice of Nightingale publications. Other experience include: Medical-Surgical, Pediatric, Obstetric, Emergency and Recovery Room Nursing.

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