Value of a modified early obstetric warning system (MEOWS) in managing maternal complications in the peripartum period: an ethnographic study
Value of a modified early obstetric warning system (MEOWS) in managing maternal complications in the peripartum period: an ethnographic study
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DOI：
10.1136/bmjqs-2012-001781
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发表时间：
2014-01-01
影响因子：
5.4
通讯作者：
Sandall, Jane
中科院分区：
文献类型：
--
作者：
Mackintosh, Nicola;Watson, Kylie;Sandall, Jane
目的探讨改进的产科早期预警系统（MEOWS）在实践中的应用，以进一步了解环境因素的影响。方法采用民族志研究方法，观察（> 120 h）、半结构式访谈（n=45）和文献回顾，对英国两家医院的产科服务进行为期7个月的研究。医生，助产士和管理人员参加了这项研究和数据进行了分析thematics.Results的妇女入院在产前和产后期间的发病率的风险，MEOWS使初级到高级助产士和产科医生的生命体征的沟通。触发提示有助于形成对孕产妇并发症的共同理解。然而，助产士和产科工作人员质疑，鉴于产妇并发症的发生率低，因此工作量增加，在产后期间增加一张图表是否有附加价值。为了优先考虑工作量需求，并满足妇女及其婴儿的迫切需要，助产士在使用时行使了专业酌处权。然而，酌情使用MEOWS意味着一个潜在的通用安全网检测恶化的损失。结论尽管在急性设置十年的使用，研究预警系统的有效性仍然产生相互矛盾的结果。对MEOWS的广泛政策支持是基于其直观的吸引力，目前不存在用于产妇的有效系统。我们的研究结果表明，虽然MEOWS在构建具有既定发病风险的住院妇女的监测方面具有价值，但在孕产途径中管理风险和安全的复杂性，MEOWS的相关机会成本以及实施中的变化目前对其常规使用的作用提出了质疑。
Objective To explore implementation of the modified early obstetric warning system (MEOWS) in practice to further understanding about the influence of contextual factors.Methods An ethnographic study using observations (>120h), semi-structured interviews (n=45) and documentary review was performed in the maternity services in two UK hospitals over a 7-month period. Doctors, midwives and managers participated in the study and data were analysed thematically.Results For women admitted to hospital in the antenatal and postnatal period with an established risk of morbidity, the MEOWS enabled communication about vital signs from junior to senior midwives and obstetricians. The trigger prompts helped shape shared understandings of maternal complications. However, midwifery and obstetric staff questioned the added value of an extra chart in the postnatal period given the low incidence of maternal complications and the resulting increase in workload. In an effort to prioritise workload demands and respond to the immediate needs of both women and their babies, midwives exercised professional discretion regarding its use. However, discretionary use of MEOWS meant the loss of a potential universal safety net for detection of deterioration.Conclusions Despite a decade of use in acute settings, research into the effectiveness of early warning systems still yields conflicting results. Widespread policy support for the MEOWS is based on its intuitive appeal and no validated system for use in the maternity population currently exists. Our findings suggest that, while the MEOWS has value in structuring the surveillance of hospitalised women with an established risk of morbidity, the complexities of managing risk and safety within the maternity pathway, the associated opportunity costs of MEOWS and variation in implementation currently call into question its role for routine use.