Document Type

DNP Project


School of Nursing

Date of Degree

Spring 2019


Doctor of Nursing Practice (DNP)

Primary Advisor

Karen Kesten, DNP, APRN, CCNS, CNE, CCRN-K, FAAN; Elzbieta Kmiecik, DNP-EL, MSA, CJCP, CCRN-K


Background: A nationwide problem that has been regularly overlooked is poor recognition of deteriorating patients which can lead to increased severity of illness. One way to avoid adverse events is early detection of clinical deterioration using vital signs via Modified Early Warning Score (MEWS). However, the majority of the hospitals across the United States are not utilizing this. MEWS implementation can minimize adverse events by early recognition, which will lead to early intervention and improved patients’ outcomes.

Objective: The aim of this quasi-experimental study was to determine if MEWS implementation will reduce the number of adverse outcomes.

Methodology: The setting is an academic, acute care, level one trauma center in mid-atlantic U.S. with 385 beds. This study used convenient sampling of adult medical surgical patients who had Rapid Response Team (RRT) or Code Blue activation. A total N=281 sample size was obtained, n=102 for the pre-MEWS and n=179 in post-MEWS implementation. A retrospective chart review was conducted to determine if there was a reduction of adverse outcomes such as cardiopulmonary arrest, unplanned ICU admission, unexpected death, or unplanned surgery after implementation.

Results: Even though it was not statistically significant, MEWS implementation demonstrated 10% reduction of unplanned ICU admission and 0.42% reduction of unplanned surgery. However, the proportion of patients requiring code blue activation significantly increased in the post-MEWS implementation (0.98% vs 8.9%) with a p value of 0.0074.

Conclusion: MEWS implementation is a valid tool to alert nurses in identifying a deteriorating patient condition for timely escalation of care.

Open Access


Included in

Nursing Commons



To view the content in your browser, please download Adobe Reader or, alternately,
you may Download the file to your hard drive.

NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern (Intel) Mac, there is no official plugin for viewing PDF files within the browser window.