Implementing the Modified Early Obstetric Warning Score (MEOWS) to Detect Early Signs of Clinical Deterioration and Decrease Maternal Mortality

Purpose for the program: To decrease maternal mortality

Proposed change: To quantify vital signs to identify early signs of deterioration

Implementation, outcomes and evaluation: A tool has been designed for the obstetric population and used in the UK, maternal deaths are decreasing and evaluation is ongoing.

Implications for nursing practice: Standardized care and a coordinated response to deteriorating condition

Keywords: maternal mortality, Early warning score

Modified Early Warning Score (MEOWS) was introduced to obstetric units in the UK to improve early detection of clinical signs of deterioration in women who were developing a critical illness.  Early warning scores have been used successfully in other areas, such as acute medicine, however these scores are not transferrable to obstetric patients, due to the normal physiological changes in pregnancy (Royal College of Physicians, 2012). The parameters of vital signs for the MEOWS chart accounts for this. 

Existing Joint Commission Standards require hospitals have a process for identifying early warning signs of deterioration and for staff to seek assistance if this occurs. A sentinel event alert concerning rising rates of maternal mortality in the USA recommends that specific changes in maternal vital signs and clinical condition should trigger a predetermined response (The Joint Commission 2010). 

MEOWS is an innovative approach to care in the field of obstetrics. It is not currently widely used in North America, however, the UK is striving to make this the gold standard across all obstetric units. A validation study MEOWS found it has high sensitivity in predicting morbidity (89%) and reasonable specificity (79%) supporting its use for obstetric patients (Singh et al, 2012). 

The philosophy behind MEOWS reflects that of the majority of validated obstetric emergency training courses (such as PROMPT, More OB, ALARM and ALSO), in that it encourages recognizing risk, implementing a coordinated approach to managing emergencies, open communication and working within a multidisciplinary team. 

MEOWS is now being incorporated into a state of the art new facility in the state of Qatar which encourages innovative practice, multidisciplinary working and evidence based practice. MEOWS can be paper based or used as part of an electronic medical record and provides a standardized approach to assessment of maternal well-being. It is incorporated into the rapid response policy ensuring clarity of staff roles and responsibilities. 

The focus on maternal mortality at AWHONN 2013 has inspired me to share this tool with obstetric nurses in the USA. Implementing MEOWS could provide a rich opportunity for nurses to develop research programs