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Kia āta kōwhiri Choosing Wisely

The Choosing Wisely campaign seeks to reduce harm from unnecessary and low-value tests and treatment.

The Health Quality & Safety Commission has developed a national maternal early warning system (MEWS) to help clinicians identify when a pregnant or recently pregnant woman’s condition starts to get worse, so they can respond quickly.

The system includes:

  • a standardised maternity vital signs chart (or electronic equivalent) with an early warning score
  • a localised escalation pathway
  • effective clinical governance and leadership
  • appropriate clinical and non-technical education and training
  • ongoing measurement for improvement
  • an escalation process for clinician, woman, family and whānau concerns.

The system is designed to identify acute deterioration in women who are admitted to a hospital during pregnancy or within 42 days of birth (not routinely during labour).

The maternity vital signs chart is based on the existing national adult vital signs chart, which the Commission has introduced to hospitals as part of its patient deterioration programme. It uses eight vital sign parameters specific to maternity to calculate a maternal early warning score. When the score is reached, it triggers a response based on the local escalation pathway, so the appropriate actions can be taken to manage the woman’s condition.

A sector-wide workshop in December 2017 agreed a national MEWS was required and testing of the new system took place during 2018. The test sites were supported by the Commission’s national programme team, which is clinician-led and includes a maternity specialist, an obstetrician/gynaecologist and an anaesthetist.

Following an evaluation by the programme team, the MMWG approved the national rollout of MEWS during 2019−20. A full compendium of tools and guidance is available to aid implementation in New Zealand hospitals.

The majority of DHBs have implemented either in maternity or hospital wide. We anticipate that all DHBs will have implemented hospital-wide by early 2021.

The Commission handed over MEWS to the Ministry of Health's maternity team for ongoing monitoring and sustainability.

For more information, please email the Ministry of Health maternity team:

Published: 21 Oct 2021 Modified: 8 Feb 2022