Applying the Modified Early Warning Score (MEWS) to assess geriatric patients in home care settings: A qualitative study of nurses’ and general practitioners’ experiences
Abstract Background : Acute functional decline is a common clinical syndrome in geriatric health care and is typically characterised by nonspecific symptoms and presentations with a mix of physical, psychological, social and functional manifestations. Early warning score (EWS) systems are widely implemented in nursing homes and home care to detect clinical deterioration. The effects of EWS systems have been thoroughly evaluated in hospital care settings, but few studies have evaluated EWS systems in community healthcare. The purpose of this study was to describe the experiences of registered nurses and general practitioners experiences when using the Modified Early Warning Score (MEWS) to support clinical reasoning and decision-making with geriatric home care patients who suffer from acute functional decline. Method: A qualitative methodology was used with a descriptive exploratory design. Data were collected from seven focus group interviews. General practitioners (GPs), and registered nurses (RNs) were purposively sampled from large, medium and small municipalities in Norway. Data were analysed using an inductive content analysis method. Results: MEWS was used as an additional decision-making tool with elderly home care patients when acute functional decline was detected. RNs and GPs highlighted that MEWS supported the clinical reasoning and decision-making process. Additionally , comprehensive reasoning skills and specific knowledge of the patients were needed. RNs identified the need for contextual adjustments to the use of MEWS in home care settings. Implementing MEWS has improved the collaboration and clinical practice of RNs and GPs. The adherence to MEWS follow-up recommendations was adjusted to the home care setting, accounting for potentially limited medical availability. Conclusion : MEWS supported RNs and GPs in conducting comprehensive clinical assessments and reasoning when acute functional decline was detected. Interdisciplinary communication and collaboration appeared to be strengthened, and the GP's work was streamlined. Several limitations were identified with the use of MEWS reference values with geriatric patients, which could lead to ambiguity and misjudgements . MEWS trigger recommendations were experienced as inappropriate to comply within home care. This study identifies the need for a modified evidence-based EWS adjusted for geriatric patients in home care.