Monitoring vital signs: development of a modified early warning scoring (MEWS) system for general wards in a developing country

PLoS One. 2014 Jan 24;9(1):e87073. doi: 10.1371/journal.pone.0087073. eCollection 2014.


Objective: The aim of the study was to develop and validate, by consensus, the construct and content of an observations chart for nurses incorporating a modified early warning scoring (MEWS) system for physiological parameters to be used for bedside monitoring on general wards in a public hospital in South Africa.

Methods: Delphi and modified face-to-face nominal group consensus methods were used to develop and validate a prototype observations chart that incorporated an existing UK MEWS. This informed the development of the Cape Town ward MEWS chart.

Participants: One specialist anaesthesiologist, one emergency medicine specialist, two critical care nurses and eight senior ward nurses with expertise in bedside monitoring (N = 12) were purposively sampled for consensus development of the MEWS. One general surgeon declined and one neurosurgeon replaced the emergency medicine specialist in the final round.

Results: Five consensus rounds achieved ≥70% agreement for cut points in five of seven physiological parameters respiratory and heart rates, systolic BP, temperature and urine output. For conscious level and oxygen saturation a relaxed rule of <70% agreement was applied. A reporting algorithm was established and incorporated in the MEWS chart representing decision rules determining the degree of urgency. Parameters and cut points differed from those in MEWS used in developed countries.

Conclusions: A MEWS for developing countries should record at least seven parameters. Experts from developing countries are best placed to stipulate cut points in physiological parameters. Further research is needed to explore the ability of the MEWS chart to identify physiological and clinical deterioration.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Consensus
  • Critical Care / organization & administration*
  • Humans
  • Monitoring, Physiologic / methods*
  • Patients' Rooms
  • Practice Guidelines as Topic
  • South Africa
  • Vital Signs*

Grant support

This work was supported by the University of Cape Town Research Development Fund and the Faculty of Health Sciences Research Committee. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.