Project Title
Utilization of Modified Early Warning Scores (MEWS) to Decrease In-hospital Cardiac Arrests (IHCA)
Date of Award
Summer 2023
Document Type
Final DNP Paper
Degree Name
Doctor of Nursing Practice (DNP) in Adult-Gerontology Acute Care Nurse Practitioner
Department
Nursing
Faculty Chair
Dr. Heather Wallace
Preceptor
Dr. Susan Thurman
Abstract
Background: Less than 25% of patients survive to discharge after an in-hospital cardiac arrest (IHCA). The American Heart Association (AHA) aimed to increase the survival to discharge after IHCA to 35%, according to the AHA Get with the Guidelines (GWTG). Pre-implementation of MEWS-based rapid response rounding the facility had a 24% survival to discharge rate after IHCA.
Purpose: The Doctor of Nursing Practice (DNP) project aimed to improve the survival to discharge percentage after IHCA by implementing MEWS-based rapid response rounding on all patients with a MEWS of four or greater.
Methods: The quality improvement project consisted of having rapid response nurses' round on patients with a MEWS of four or greater. The rapid response nurses utilized the rapid response protocols, triaged calls, and assessed patients while attending physicians were informed as appropriate.
Results: Key results included a decrease in IHCA with MEWS-based rapid response rounding from 0.80 to 0.25 IHCA per 1,000 occupied patient beds. The facility had one IHCA after MEWS-based rapid response rounding was implemented. Unfortunately, the patient did not survive to discharge, which did not improve the survival to discharge rate after IHCA. Since the survival to discharge rate was not improved, the American Heart Association (AHA) Get with the Guidelines (GWTG) goal of 35% was unmet. Additional vital results included decreased rapid response calls from 31.2 to 29 rapid responses per 1,000 occupied patient beds. However, there were fifty-one patients with an elevated MEWS or 12.8 MEWS per 1,000 occupied patient beds. A decrease in the number of ICU transfers was also seen from 10.2 to 8.5 ICU transfers per 1,000 occupied patient beds.
Conclusion: The DNP project helped stress the importance of utilizing MEWS-based rapid response rounding to decrease the amount of IHCA that occurs and decrease the amount of ICU transfers that occur. The DNP project revealed the facility did not meet the AHA GWTG goal of 35% of patients surviving to discharge after an IHCA. Additional investigation is needed to determine the optimal method for improving survival to discharge after IHCA and decreasing the number of IHCA that occurs.
Recommended Citation
Bryan, Ashley, "Utilization of Modified Early Warning Scores (MEWS) to Decrease In-hospital Cardiac Arrests (IHCA)" (2023). Doctor of Nursing Practice Projects. 97.
https://digitalcommons.jsu.edu/etds_nursing/97