Hand and Plastics Call
Gentle reminder that if there is no plastics coverage, there is likely someone covering hand surgery that day. If you have a hand injury, check both call schedules — either service can see the hand injuries.
Allied Health Rx's
FYI there is now a script that prints referrals to physio, chiropractors, or RMTs.
Pacemakers
From Dr Chan:
I would kindly remind everyone to avoid putting any foreign material such as sutures over a fresh incision site as this can increase the risk of infection. If there is concern for bleeding, then the bloody dressing can be replaced with a sterile pressure dressing or steri-strips can be applied in a sterile fashion. If non-significant bleeding, best for patient to ultimately follow up with the pacemaker clinic without any of the above interventions so we can tend to the wound directly. We can usually accommodate same-day service.
Peds RAP Scheduling Changes
FYI the appointments are now being made by the scope nurse the next business day. There is a patient handout in the ERs to provide to the families being referred.
Sickle Cell Transfusions
FYI the blood bank needs to know if you are transfusing a patient with Sickle Cell Disease.
The transfusion order has a field for special info where this notice can be added. The process for obtaining the correct blood type is more robust for patients requiring multiple transfusions. The lab is working on their internal process to further reduce risk, but in the interim, better to flag for the lab (I'll be putting a note in the comments field when ordering blood).
Lab Updates
See the attached memos regarding Hepatitis ordering and a change in the lab results view which shows trends more easily.
Remote Access
Attached a copy of the various ways to get remote access.
📄 Remote Access for Staff & Providers
New Splints
Just wanted to bring to your attention that we have brought in a sub for the Gypsona slab bandages. The only main difference is that it sets in 4 minutes rather than 2 minutes like the prior slabs — may need to be cut to fit your needs as well.
MEOWS — Modified Early Obstetrical Warning System
FYI team — this will be implemented in the ER in the near future and wanted everyone to know.
What is MEOWS?
The Modified Early Obstetrical Warning System (MEOWS) is a standardized tool used to monitor physiological parameters in pregnant and postpartum patients (greater than 20 weeks gestation and less than 6 weeks postpartum). It helps clinicians identify early signs of clinical deterioration (sepsis, hemorrhage, preeclampsia, or cardiopulmonary complications) by assigning color-coded scores to vital signs and other parameters. The escalation pathway prompts timely clinical assessment and intervention.
Why MEOWS in the ED?
Pregnant and postpartum patients have unique physiological adaptations that make traditional early warning tools less reliable. Using MEOWS in the ED could aid in early recognition of clinical deterioration leading to improved outcomes, as delays in recognizing complications are contributors to preventable pregnancy and postpartum related morbidity and mortality.
Process for using MEOWS
Nursing charts vital signs and other parameters in Cerner (see attached for Cerner views). If parameters score two yellow or one red on the MEOWS scoring criteria, a discern alert will automatically be generated. The discern alert will prompt the nurse to notify the MRP.
Workflow in the ED: primary RN notifies charge RN, who would then notify the ED physician. ED physicians would not get a discern notification pop-up — only nursing.
Why use MEOWS if we have Sepsis alerts in ED?
MEOWS alerts to more than just clinical deterioration because of an infection — it is for any pregnancy or postpartum complications.
Pregnancy alters "normal" vital sign ranges, making SIRS and sepsis criteria less reliable. MEOWS flags abnormal values that are significant within pregnancy physiology.
SIRS alerts (early warning system for infection) are turned off in the ED. MEOWS acts as an early warning tool to prompt potential investigation and management (including for sepsis).