Showing posts tagged with: 'MEOWS'


MEOWS: Recommended

Sat 25th Apr 2009 by Ben Palmer.

I spend a lot of time campaigning for the national use of Modified Obstetric Early Warning System (MEOWS) chart, and indeed I was in Oxford yesterday talking to some midwifery students about their use, and the difference they would almost certainly have made to Jessica.

Not everybody always immediately shares my enthusiasm for them. I've been challenged more than once. It has even been suggested to me that the NHS isn't ready for them. Tosh. In December 2007 I learnt that an estimated 10% of NHS Trusts were using them, and that figure is increasing as MEOWS is adopted Trust by Trust, even if only for high risk mothers. What is a high risk mother? Jessica wasn't but she died. Every mother should be followed for the first 10 days after delivery by her own MEOWS chart, I believe.

As for being a lone voice - this is what the Confidential Enquiry into Maternal and Child Health (CEMACH) said in it's top 10 recommendations to save mothers' lives in it's 2007 report, using prevention of deaths from sepsis as an example:

Early warning scoring system

9. There is an urgent need for the routine use of a national obstetric early warning chart, similar to those in use in other areas of clinical practice, which can be used for all obstetric women which will help in the more timely recognition, treatment and referral of women who have, or are developing, a critical illness. In the meantime all trusts should adopt one of the existing modified early obstetric warning scoring systems of the type described in the Chapter on Critical Care, which will help in the more timely recognition of woman who have, or are developing, a critical illness. It is important these charts are also used for pregnant women being cared for outside the obstetric setting for example in gynaecology, Emergency Departments and in Critical Care.

Rationale

In many cases in this Report, the early warning signs of impending maternal collapse went unrecognised. The early detection of severe illness in mothers remains a challenge to all involved in their care. The relative rarity of such events combined with the normal changes in physiology associated with pregnancy and childbirth compounds the problem. Modified early warning scoring systems have been successfully introduced into other areas of clinical practice and a system which has been modified for obstetric mothers is discussed in Chapter 19, together with an example of such a chart. These should be introduced for all obstetric admissions in all clinical settings.

In developing this recommendation, a consultant from a hospital where staff are trying to get such a scheme introduced said “we have had three near misses related to unrecognised sepsis in the last two months, all of which would have been picked up by this chart. All three women came close to featuring in the next edition of your Report”.

Auditable standards

  • A National Modified Obstetric Early Warning System (MEOWS) chart developed and piloting started by December 2008.
  • In the interim, the number of trusts who have adopted a version of any existing MEOWS charts and trained all staff in its use by the end of 2008

Lewis, G (ed) 2007. The Confidential Enquiry into Maternal and Child Health (CEMACH). Saving Mothers’ Lives: reviewing maternal deaths to make motherhood safer - 2003-2005. The Seventh Report on Confidential Enquiries into Maternal Deaths in the United Kingdom. London: CEMACH.

Update: The report link has moved to the new CMACE website

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Life saving treatment wanted asap

Sun 1st Mar 2009 by Ben Palmer.

I'm not just blogging blindly; I'm interested in what other people think and say, and I also am interested in how people find this website, and where people are linking to it.

I watch referring sites in my log stats, and often visit back. It was in this way that I came across a parenting forum this weekend.

A mother of three posted with a link to Jessica's Trust, urging people to read the information contained herein and, if they feel as strongly as she does, to sign the petition.

I was, though, dismayed to read a third reply to her post, from another mum, who didn't think that MEOWS charts were necessarily a good thing. She felt they could lead to unjustified intervention, use of prophylactic antibiotics, and only benefit 1 in half a million women.

Oh how I was dismayed! Where do I begin?

Midwives already take temperatures and observations. They already record them in a mother's notes. If there were more midwives who had more time to spend with the increasing number of mothers delivering and recorded observations more frequently, that would be a good thing. Surely no one would dispute that.

The use of MEOWS charts - which is already standard in a small but growing number of units - is widely supported and encouraged. It is not a new test/observation, but a different and inherently clearer way of recording observations. This means that a women who is beginning to deteriorate will be picked up faster and given any treatment that she requires for a range of conditions including, but not exclusively, childbed fever (CF). This means that severe illness and/or death can be avoided.

I am not an advocate of prophylactic use of antibiotics, indeed more women than are saved from sepsis may die of allergic reaction.

As for benefitting only 1 in 500,000 - how wrong is this. Purely looking at sepsis, in 2003-2005 the Confidential Enquiry into Maternal and Child Health recorded 18 deaths (0.85 per 100,000) from Genital tract sepsis (GTS). This would be 4.25 per 500,000, but more women than that give birth in this country each year. The average number of deaths per annum from GTS/CF is 6.

Far, far more are affected (no data is recorded, but it should be) by childbed fever than this. I continually hear tragic stories of illness from survivors.

Would any of them not have wanted to receive earlier antibiotic treatment?

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NHS Trust apology: maternal deaths

Fri 13th Feb 2009 by Ben Palmer.

From the Nursing Times today:

In the Gwent Healthcare NHS Trust, 'earlier identification of deterioration, or better advance preparation to manage identified risk, may have averted the deaths'.

Link to article: NHS trust apologises over 'exceptionally high' maternal deaths

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Don't miss the bear

Wed 11th Feb 2009 by Ben Palmer.

When I spoke in Basingstoke, at the SE Regional conference a little while ago, one of the highlights was this video, shown by one of the other speakers.

Concentrate hard and follow the instructions.

When we watched it there was a big cheer as everyone got the correct answer, and then a gasp!

I had a letter today, from CEMACH, with some of the comments made by the (mainly midwife) delegates at the South East Regional CEMACH conference in Basingstoke Jan 2009, in their evaluation forms. To underline the purpose of Jessica's Trust, the campaign and our petition, I thought I'd share a few:

  • Jessica's story highlighted the need for MEOWS on the postnatal wards
  • Jessica's story of tragedy shows the importance of how not to miss the bear moon-walking amidst the data.
  • High quality communication, referral & follow ups is vital to good provision of care - information should be provided to all women in a way that they can understand it + make choices about their care. - I will always remember Jessica's story.
  • Importance of observation! To re-emphasis use of MEOWS.
  • Higher awareness in units regarding newly introduced MEOWS.
  • Considering how to take forward Ben's message in practice.
  • Copy of MEOWS chart of postnatal women's observations to community midwives.
  • Jessica's story increasingly moving.
  • The presentation from Ben was extremely poignant and completely sums up the purpose of CEMACH - Very powerful and real life experience should be portrayed to many more maternity staff - it keeps the reality in the midst of statistics and risk.
  • There is a need for an early warning system to be implemented in trusts. We need to ensure that women are aware of risks & that there are guidelines for e.g. sepsis in pregnancy.

Thank you to CEMACH for inviting me to speak, and for permission to use these comments.

[It has to be said, it's more of a surprise if the video isn't titled before you watch it!]

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Help us by signing our petition

Tue 3rd Feb 2009 by Ben Palmer.

Jessica's Trust needs your help

Please sign our petition

We have started a new petition on the Downing Street website, asking the Prime Minister to...

"...ensure that every new mother has regular observations recorded on a Modified Early Obstetric Warning System (MEOWS) chart in hospital and in the community and is given clear information and advice on the recognition of childbed fever (also known as puerperal fever and genital tract sepsis) and that doctors and midwives are given clear sepsis guidelines."

More information

This petition will remain open for 9 months.

However, please sign our petition now, with one name per line - signing as 'Mr & Mrs Smith' will only count as one signature! Every British citizen or resident can sign if they have a unique email address.

When you have signed please remember to click the link in the confirmation email you will receive, then please  share the link to this page with anybody who you think might like to sign it as well.

For more information about the petition, childbed fever, MEOWS and Jessica's Trust please read our website.

Online donations and fundraising

Since becoming a registered charity, we have partnered with Justgiving.com to allow us to receive online donations.

All money donated or raised through sponsorship will enable us to continue raising awareness of childbed fever through printing and distributing leaflets and posters, running our website and striving to achieve our aims.

Keep up to date with our work

Bookmark our website or join our update list to keep abreast of what we're doing.

Thank you

Thank you for your help. Together we can make a difference.

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What is childbed fever?

Childbed fever is an infection of the womb in new mothers which can lead to septicaemia. If left untreated infection will cause organ failure and death - even in young, fit mothers.
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What are the symptoms? »
Childbed fever: the facts »

What's the aim?

We would like every parent and every midwife and doctor to know that childbed fever is still a very real threat to a mother's life.
more »
Can I help? »

Who is Jessica?

Jessica Palmer was a Mum. She died in June 2004, at 34 years old, of childbed fever caused by Group A streptococcus.
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This website contains general information about childbed fever. The information is not complete or comprehensive. You should not rely on the information on this website as an alternative to medical advice from your doctor or healthcare provider. If you have any specific questions about childbed fever (or any other medical condition) you should consult your doctor or other healthcare provider; and if you think you may be suffering from childbed fever (or any other medical condition) you should seek immediately medical attention. You should never delay seeking medical advice, disregard medical advice, or discontinue medical treatment because of information on this website.
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