Early warning scores and trigger recommendations must be used with care in older home nursing care patients: Results from an observational study.
Kristin Jeppestøl, Marit Kirkevold, Line K Bragstad
PMID 36916829WHAT IT FOUND
Older home nursing care patients with suspected decline had median MEWS 1, so most scores would not trigger referral, yet nurses referred many.
Use MEWS with clinical judgement, not alone.
Key findings
01In 444 suspected-decline MEWS assessments, the median score was 1 (IQR 1-2), and 432 scores were 0 to 4.
02Habitual MEWS were available for 51 patients, and compared with acute scores, 47% increased, 35% unchanged, and 18% decreased (p = 0.002).
03RNs followed trigger recommendations in 306 of 444 cases, but 137 referrals were made when the score was 0 to 4.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study included 135 patients from a population of 1214 home nursing care patients aged 65 or older in eight municipalities, and the authors note possible sample selection bias because people who declined or were too ill were not recorded. Habitual MEWS was available for only 51 patients (37.8%), so comparisons with a stable baseline were limited. The study did not record what caused the functional decline or what happened after the first 3 months. The recorded habitual scores could be old, because their age was not known. The study used records and scores only, so it cannot fully show how nurses made decisions. All patients were receiving home nursing care in southern Norway, and the authors state generalising was not the purpose.
The easy way to misread this
Do not read a low MEWS as evidence that acute illness has been ruled out. In this study, 432 of 444 suspected-decline scores were 0 to 4, and 137 referrals were made despite those scores.