Cornwall hospital rolls out new deterioration tool on paper to mitigate digital wait

Highlights 

• NHS England is rolling out a new standardised version of the Maternal Early Warning Score (MEWS).  

• In Cornwall, Health Innovation South West has supported the NHS Trust to implement the new MEWS on paper across departments, ahead of the launch of its new digital patient record system.    

• Deteriorating women across inpatient, maternity, adult, emergency and community settings are now being managed in a consistent way. 

• It’s the first case of NHS Trust-wide paper-based rollout of MEWS, beyond obstetric settings, in the South West. 

Royal Cornwall Hospitals NHS Trust (RCHT) has implemented a new standardised tool to spot and manage deteriorating pregnant women on paper, ahead of the launch of its upcoming digital patient record system.  

With implementation support from Health Innovation South West, inpatient, maternity, adult, emergency and community settings across RCHT now have access to the new national Maternal Early Warning Score (MEWS) – ensuring deteriorating pregnant and postpartum women are managed in a consistent way, ahead of the move from analogue to digital patient records. It’s the first Trust-wide paper-based rollout of the new tool, beyond obstetric settings, in the South West.  

MEWS is an observation chart designed to help the clinical approach to recording vital signs in antenatal and postnatal patients and when to escalate a response. Its use and implementation vary across the country, which has led NHS England to roll out a new standardised version of the tool.   

The national MEWS, available in paper and digital form, is being deployed in some trusts as part of their new electronic patient record systems.  

In Cornwall, where electronic patient record system eCare is going live this summer, staff have worked collaboratively to bring forward implementation by rolling out the new MEWS chart on paper – and widening its implementation across clinical and community settings.   

Jane Pascoe, Intrapartum Maternity Matron at RCHT, explained the trust took a multi-disciplinary approach to planning and implementing the new tool safely on paper. 

We formed a working party. Team leaders, ward leaders, community teams and colleagues from audit, guidelines, and patient safety all contributed. Obstetrics and anaesthetics have been engaged and supportive at every stage.

As a group, we mapped out where MEWS fits within existing guidelines, made all the amendments, and worked through what the escalation pathway looks like for our Trust. This was supported with conversations with the national implementation team.”  

RCHT decided to roll out MEWS beyond inpatient maternity settings, where they were originally used. Explains Jane: 

The charts have gone to our key areas like the Emergency Department, main theatre recoveries, gynaecology, and places where pregnant people might be.”  

Outside of hospital, sats probes were already in use by the trust to enable staff to take MEWS observations in full in the community.  

Since its implementation, anyone who is more than four weeks’ pregnant can be monitored in a consistent way. Jane said:

Standardising MEWS provides clear, predictable escalation steps that all staff understand. “It reduces delays, prevents missed communication, and ensures that the right level of support is activated at the right time, no matter the clinical setting. With trainees rotating in the South West, a unified MEWS chart removes confusion and eliminates the need to relearn local processes.” 

While the team at RCHT deployed MEWS as a paper booklet, they effectively engaged their staff through digital means. Jane explains:

For seven weeks preceding our launch date, we put a weekly educational pop-up on staff computer screens with a different theme and links to online training. Key changes with the MEWs were highlighted including the concerns box, urine output and postnatal pulse. This pop-up came up on everybody’s PC when they started their computer, so there was no getting away from it. They work really well for us, providing important learning and updates.”  

RCHT intends to change to a digital version of MEWS when eCare is live later this year. Having staff across the hospital already trained in the new MEWS tool will ease the change, having laid out the groundwork for adoption of a digital version. 

When we move to digital, it’s just learning [MEWS] in its digital form, rather than learning the new MEWS scores and escalation pathways. The awareness [of MEWS as a tool] will be there because we have already implemented the tool.”

Our small recent survey of RCHT staff, mostly midwives and maternity support workers, suggests the national MEWS is helping to improve early recognition and structured monitoring. However, challenges including high workload, clinical context, familiarity with the tool, and parameter suitability, are influencing how effectively it is used by staff across ward, ED, and community settings. 

As for the impact MEWS is having on deteriorating patients cared for by RCHT in the meantime? Says Jane: 

Time will tell when we have enough audit data and we can also audit pregnant people outside of maternity. But we’ve made headway [with the new MEWS], which is the best part.”  

At Health Innovation South West we have been supporting NHS Trusts in the South West through 2025-26 to embed the new standardised MEWS as part of the PIER (Prevention, Identification, Escalation, Response) framework. Join us on 31 March 2026 for our free PIER-focused perinatal safety event. Register now.