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  • Imews Escalation Guide PDF

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    Daeng Farahnaz
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    The document provides guidelines for escalating care of patients based on their Irish Maternity Early Warning System (IMEWS) score. It indicates that for 1 yellow trigger, observations should be repeated in 30-60 minutes, while for 2 yellows or 1 pink, the obstetrician should be notified to review and observations repeated in 30 minutes. For more than 2 yellows or 2 or more pinks, the obstetrician should be called for immediate review and observations repeated within 15 minutes or monitored continuously. It also provides criteria for suspecting and intervening in cases of maternal sepsis.

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    The document provides guidelines for escalating care of patients based on their Irish Maternity Early Warning System (IMEWS) score. It indicates that for 1 yellow trigger, observations should be repeated in 30-60 minutes, while for 2 yellows or 1 pink, the obstetrician should be notified to review and observations repeated in 30 minutes. For more than 2 yellows or 2 or more pinks, the obstetrician should be called for immediate review and observations repeated within 15 minutes or monitored continuously. It also provides criteria for suspecting and intervening in cases of maternal sepsis.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    124 views2 pages

    Imews Escalation Guide PDF

    Uploaded by

    Daeng Farahnaz
    The document provides guidelines for escalating care of patients based on their Irish Maternity Early Warning System (IMEWS) score. It indicates that for 1 yellow trigger, observations should be repeated in 30-60 minutes, while for 2 yellows or 1 pink, the obstetrician should be notified to review and observations repeated in 30 minutes. For more than 2 yellows or 2 or more pinks, the obstetrician should be called for immediate review and observations repeated within 15 minutes or monitored continuously. It also provides criteria for suspecting and intervening in cases of maternal sepsis.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    of 2

    Hospital Name: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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    Addressograph

    Irish Maternity Early Warning System (IMEWS)


    Escalation Guideline Version 1.1

    ALL IMEWS TRIGGERS


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    1 YELLOW 2 YELLOWS OR 1 PINK >2 YELLOWS OR •3,1.6


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    ALL IMEWS TRIGGERS


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    IMPORTANT:
    1. If concerned about a woman, escalate care regardless of triggers.
    2. If action is not carried out as above, CMM/Midwife in charge must contact the
    senior obstetrician on duty.
    3. Document all communication and management plans in notes.

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    AND Appropriate cultures*
    • Temperature •8°CRU°C
    • Respiratory rate •0 breaths per min IILnIHFtLon TAK( FBC +/- lactate
    LVVXVSHFtHG Start urine output chart
    • Heart rate • beats per min
    aIWHUmHGLFaO 40DLQWDLQ22 (4-%)
    • White cell count >or <4[/L
    UHYLHZ GIVE  5 Consider IV fluid bolus**
    ‡%HGVLGHJOXFRVH!PPRO/ IV antibiotics
    (in the absence of diabetes)
    *egEORod, wound, vaginal swab, urine etc
    • Acutely altered mental status **exercise caution in presence of pre-eclampsia
    IMEWS Triggers Key
    IMEWS Trigger Normal Values Yellow Zone Pink Zone
    Document Number Respiratory rate (bpm) 11-19 20-24 ”10 or •25
    (eg. 1, 2):
    SpO2 (%) 96-100 - ”95
    Temperature (ºC) 36.0-37.4 35.1-35.9 or 37.5-37.9 ”35 or •38
    Booking BP: Maternal HR (BPM) 60-99 50-59 or 100-119 <50 or •120
    Systolic BP (mmHg) 100-139 90-99 or 140-159 <90 or •160
    Gestation at Diastolic BP (mmHg) 50-89 40-49 or 90-99 <40 or •100
    Booking (weeks): Voice, Pain or
    AVPU Alert - Unresponsive

    Contact appropriate doctor for early intervention if the woman triggers one PINK
    P or two YELLOW zones at any one time
    Year:
    Year: Date :
    _______ Time :
    Time
    ™
    ™ ™
    ™
    Resp. Rate
    per min

    
     
    
    11-19 11-19
    ˜
    ˜ ˜
    ˜
    Resp.Rate

    96-100% 96-100%
    TTriggers

    SpO2
    only if
    riggers

    ˜ 95%
    ˜95% ˜ 95%

    ™
    ™ ™ 
    ™
    
     
    
    Temp
    Teemp °C

    
     
    
    
     
    
    ˜
    ˜ ˜
    ˜
    

    120 120
    110
    Maternal Heart Rate

    110
    110
    100 100
    90 90
    
     
    
    
     
    
    60 60
    50 50

    110
    0 
    
    160
    160 160
    150 150
    Systolic Blood Pressure

    
     
    
    
     
    
    120 120
    110
    110 110
    100 100
    90 90
    
     
    
    
     
    
    Diastolic Blood Pressure

    110 110
    100
    100 100
    90 90
    
     
    
     
    60 60
    50 50
    
     
    

    Protein Protein
    Urine

    Glucose Glucose

    Other Other

    Pain Score 0-10 Pain Score

    Alert (A) A
    AVPU
    AVPU Neuro Voice (V) V
    Response Pain (P) P
    Unresponsive (U) U

    TTotal
    otal Y
    Yellow
    ellow Zones TTotal
    otal yellow
    zones
    Total Pink Zones
    Total TTotal
    otal pink
    zones

    Initials Initials

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