Implementation of the Modified Early Obstetric Warning System (MEOWS) in Obstetric Patients Within a Level IV Maternal Care Facility

Practice Problem: Incidences of increasing maternal morbidity and mortality are often preceded by a period of unrecognized deterioration. The lack of an obstetric early warning system in a high-risk Level IV Maternal Care Facility further contributed to delayed identification and intervention of deteriorating mothers. PICOT: The PICOT question that guided this DNP project was, in obstetric patients, 18-years or older (P), does the Modified Early Obstetric Warning System (MEOWS) (I), compared to current standard practice (C), affect the number of patients transferred to the ICU (O) within a six-week time frame (T)? Evidence: Nine evidence-based articles were included in this DNP project, consisting of quasi-experimental, nonexperimental, and systematic review designs. The evidence overwhelmingly supported the use of an obstetric specific early warning system due to the physiologic and hemodynamic changes associated with pregnancy, labor, delivery, and postpartum period. Intervention: The Modified Early Obstetric Warning System (MEOWS) was an early warning system designed to recognize signs of early deterioration in obstetric patients, which prompted actions from the healthcare team. The system included nine parameters scored by the bedside nurse, the higher score indicated higher acuity. Based on the score, the healthcare team implemented appropriate interventions. Outcome: Two out of 117 patients (0.81%) were transferred to the ICU within the six-week DNP project timeframe. In the previous year, 25 out of 3,097 patients (1.71%) were transferred to the ICU. ICU transfers increased by 111% and the MEOWS was not statistically significant (p = 1.000). Conclusion: Emphasis was placed on the clinical significance of a standardized method to recognize deteriorating obstetric patients across multiple disciplines, increased support of the bedside nurse, and improved patient care.