Record Review to Explore the Adequacy of Post- Operative Vital Signs Monitoring Using a Local Modified Early Warning Score (Mews) Chart to Evaluate Outcomes

Objectives: 1) To explore the adequacy of: vital signs ’ recordings (respiratory and heart rate, oxygen saturation, systolic blood pressure (BP), temperature, level of consciousness and urine output) in the first 8 post-operative hours; responses to clinical deterioration. 2) To identify factors associated with death on the ward between transfer from the theatre recovery suite and the seventh day after operation. Design: Retrospective review of records of 11 patients who died plus four controls for each case. Participants: We reviewed clinical records of 55 patients who met inclusion criteria (general anaesthetic, age.13, complete records) from six surgical wards in a teaching hospital between 1 May and 31 July 2009. Methods: In the absence of guidelines for routine post-operative vital signs ’ monitoring, nurses ’ standard practice graphical plots of recordings were recoded into MEWS formats (0 = normal, 1–3 upper or lower limit) and their responses to clinical deterioration were interpreted using MEWS reporting algorithms. Results: No patients ’ records contained recordings for all seven parameters displayed on the MEWS. There was no evidence of response to: 22/36 (61.1%) abnormal vital signs for patients who died that would have triggered an escalated MEWS reporting algorithm; 81/87 (93.1%) for controls. Death was associated with age, $61 years (OR 14.2, 3.0–68.0); $2 pre-existing co-morbidities (OR 75.3, 3.7–1527.4); high/low systolic BP on admission (OR 7.2, 1.5–34.2); tachycardia ($111