NAME CHART OF YEAR

DATE of
BIRTH
Unit No./NHS No. WARD MONTH
MONITORING PLAN (To include observations to be monitored and any changes to accepted parameters)
DATE Frequency PARAMETERS Sign

DATE DATE
TIME TIME
≥ 30

Respiratory
21 - 29

Rate
15 - 20
8 -14
≤8
≥ 95

Saturation
Oxygen
90-94
86-89
≤ 85
Flow Oxygen
Device Therapy

40 40
39.5 39.5
39 39
Temperature °C

38.5 38.5
38 38
37.5 37.5
37 37

Temperature
36.5 36.5
36 36
35.5 35.5
35 35
34.5 34.5
N.B. It is the SYSTOLIC BP which is used to trigger the MEWS score

220 220
210 210
200 200
190 190
180 180
170 170
160 160
150 150
140 140
Blood Pressure (mmhg)

130 130
120 120
110 110
Heart Rate (bpm)
100 100
90 90
80 80
70 70
60 60
50 50
40 40
30 30
AVPU/NC AVPU/NC

Observation Please initial

Performed by box

KEY 0 1 2 3 KEY
RR
SpO2
SCORES
MEWS

Temp
SBP
HR
AVPU
Urine
Mews Mews
Total Total
 MEWS SCORING PARAMETERS
OBSERVATION 3 2 1 0 1 2 3
RESPIRATORY
RATE
Less than 8 8 - 14 15 - 20 21 - 30 More than 30
OXYGEN
SATURATION
Less than 85% 85 - 89% 90 - 94% 95% or More
°
TEMPERATURE Less than 35 C 35 - 35.9°C 36 - 37.9°C 38 - 39°C More than 39°C
SYSTOLIC BLOOD
PRESSURE
Less than 70 70 - 80 81- 100 101 - 179 180 - 199 200 - 220 More than 220
HEART RATE Less than 40 40 - 50 51 - 100 101 - 110 111 - 129 More than 130
New Confusion Alert (A) or Responds to VERBAL Responds to
UNCONCIOUS
AVPU (NC) or long standing (V) PAINFUL (P)
Confusion/Dementia stimuli only (U)
Agitation (A) stimuli only

URINE Less than More than

10 - 30mls/hr
OUTPUT 10mls/hr 30mls/hr
GUIDELINES FOR USING THE MEWS CHART
™ Physiological observations should be monitored and recorded at least every 12 hours (See observation guidance)
™ When an observation falls outside the grey range (score = 0), then you MUST calculate the MEWS score for all parameters
™ Respiratory rate must be recorded EVERY time observations are performed. They should be observed over 1 FULL minute and
recorded as a numerical value i.e. 14 Depth, symmetry and pattern of respiration should be noted and recorded if abnormal
™ If any of the physiological observations fall outside the graphical range, record the finding as a numerical value on the chart
™ A patient’s heart rate should be determined by MANUAL palpation. The RHYTHM should be noted and recorded if irregular
™ If a patient’s heart rate falls outside normal parameters and there isn’t a known cause or established treatment plan,
ALWAYS perform a 12 Lead ECG
™ If URINE OUTPUT is not documented or unknown assume the output is NORMAL and score ZERO. ALWAYS commence a strict
FLUID BALANCE chart if the MEWS score reaches 6 or MORE, or rises by 3 or MORE from the previous score. After a further 4
hours without urine output, call for advice, scan the patient’s bladder and/or consider a urinary catheter. Send urgent bloods for UREA
and ELECTROLYTES.
If the TOTAL MEWS score falls within the range of 1-5, observations should be performed a minimum of 4 hourly. The nurse
in charge must be kept informed of the patient’s condition and management. Consider the following simple interventions:
™ Has the patient received all vital ™ Is the patient receiving the prescribed ™ Are there any appropriate P.R.N
medication? amount of oxygen? medications that could be given?
™ Is the patient’s position optimised for ™ Are all prescribed infusions running on ™ Simple physiotherapy
their condition? time? (Deep breathing/coughing)
™ Is the patient on a Fluid Balance Chart? Review input and output and plan your care/actions accordingly

MEWS ESCALATION PLAN

PRIORITY ONE PRIORITY TWO PRIORITY THREE
A score of 3 in any single parameter
A rise of 3
A rise of 3 or more from TOTAL MEWS A rise of 3 or more TOTAL MEWS
TOTAL MEWS previous score – even if or more
score of 8-14 or within this range score 15-21 or
score of 6-7 or the total score remains within this range
less than 6

This patient group is at high risk of

Contact a NP / Team Doctor / Outreach CATASTROPHIC
Contact a Nurse Practitioner (NP)/ for an immediate patient review
Team Doctor / Outreach DETERIORATION
They should contact the
for patient review and advice Contact NP / Team Doctor / Outreach
Registrar/Consultant for advice and this
re: clinical management for an IMMEDIATE patient review
should include advice re: ICU referral
Perform hourly observations (obs) Perform ½ hourly obs until It is essential that the patient is
the patient is reviewed reviewed by a REGISTRAR or
until the patient is reviewed CONSULTANT
If a PRIORITY TWO TOTAL MEWS
If a PRIORITY ONE TOTAL MEWS score rises by 3 or more despite Consideration of an urgent
score rises by more than ICU referral is needed
interventions/therapies, contact
3 from previous reading Registrar for further advice Remain with the patient until the
despite interventions/therapies, NP/Doctor arrives.
escalate and action PRIORITY TWO
Score greater than 14 escalate to
PRIORITY THREE Perform ¼ hourly obs
until the patient is reviewed
Ensure all relevant clinical data is available i.e. MEWS chart / Most recent blood results /
Patient notes / Prescription Chart / Investigation Results
Check blood sugar and commence a strict fluid balance chart
Establish IV access and send urgent bloods as directed.
Consider obtaining a 12 Lead ECG and the use of a cardiac monitor where appropriate.

DEVICE CODES FOR OXYGEN DELIVERY RM Reservoir Mask A AIR

Humidified Oxygen @ 28% Venturi 24%
H28 V24 TM Tracheostomy Mask NC Nasal Cannulae
Also H35 H40 H60 H80 H98 Also V28 V35 V40 V60
CP Patient on CPAP system NIV Patient on NIV system SM Simple Mask OTH Other device (specify)