The experiences of nurses implementing the Modified Early Warning Score and a 24-hour on-call Mobile Intensive Care Nurse: An exploratory study

2016 ◽  
Vol 34 ◽  
pp. 33-41 ◽  
Author(s):  
Siv K. Stafseth ◽  
Sturle Grønbeck ◽  
Tine Lien ◽  
Irene Randen ◽  
Anners Lerdal
1999 ◽  
Vol 12 (3) ◽  
pp. 109-118 ◽  
Author(s):  
Therese Clarke ◽  
Elizabeth Mackinnon ◽  
Kerry England ◽  
Gayle Burr ◽  
Sue Fowler ◽  
...  

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Donna M Miller

A change in patient condition is a dynamic process which can go unrecognized and result in a failure to rescue. Changes in patients’ vital signs can precede adverse events many hours before critical events such as cardiac arrest or emergent transfer to the Intensive Care Unit occurs. Quantitative assessment tools are used to predict risk and need for additional resources at the bedside. These tools are referred to as Early Warning Scoring Systems. The Royal College of Physicians developed a standardized tool called the National Early Warning Score (NEWS, 2012) that uses a variety of physiologic parameters to assess risk and establish a trigger threshold for summoning additional resources. Purpose: Early warning scoring tools have been found to be reliable and accurate in predicting patient decompensation. However, data from instruments are only as reliable and accurate as the caregiver who obtains and documents the parameters. The purpose of this study was to establish inter rater reliability between the RN and PCA using NEWS. Design, Sample, Setting, Procedures: This study was conducted on the clinical units of a 104 bed Long Term Acute Care Hospital (LTCH) system. These units accept patients directly from Intensive Care Units who require intense services to maintain their trajectory toward recovery. The NEWS provides a way for early detection of patient decompensation which can prevent readmission to acute care and the subsequent financial implications The convenience sample consisted of 22 RNs and 6 PCAs. Consented subjects reviewed an unfolding case study that portrayed a typical patient on the LTCH unit. Subjects were asked to circle the parameter ranges on the NEWS tool that corresponded to physiologic values in the scenario. Findings: Krippendorff’s alpha was utilized to determine the level of agreement among the raters examining the three scenarios. An alpha value of 0.94 was obtained indicating a high level of agreement among the raters. Conclusion: The NEWS can serve as a reliable adjunct to the provision of safe patient care. While it is not the sole source for determining


2018 ◽  
Vol 25 (6) ◽  
pp. 324-330 ◽  
Author(s):  
Wang Chang Yuan ◽  
Cao Tao ◽  
Zhu Dan Dan ◽  
Sun Chang Yi ◽  
Wang Jing ◽  
...  

Background: For critical patients in resuscitation room, the early prediction of potential risk and rapid evaluation of disease progression would help physicians with timely treatment, leading to improved outcome. In this study, it focused on the application of National Early Warning Score on predicting prognosis and conditions of patients in resuscitation room. The National Early Warning Score was compared with the Modified Early Warning Score) and the Acute Physiology and Chronic Health Evaluation II. Objectives: To assess the significance of NEWS for predicting prognosis and evaluating conditions of patients in resuscitation rooms. Methods: A total of 621 consecutive cases from resuscitation room of Xuanwu Hospital, Capital Medical University were included during June 2015 to January 2016. All cases were prospectively evaluated with Modified Early Warning Score, National Early Warning Score, and Acute Physiology and Chronic Health Evaluation II and then followed up for 28 days. For the prognosis prediction, the cases were divided into death group and survival group. The Modified Early Warning Score, National Early Warning Score, and Acute Physiology and Chronic Health Evaluation II results of the two groups were compared. In addition, receiver operating characteristic curves were plotted. The areas under the receiver operating characteristic curves were calculated for assessing and predicting intensive care unit admission and 28-day mortality. Results: For the prognosis prediction, in death group, the National Early Warning Score (9.50 ± 3.08), Modified Early Warning Score (4.87 ± 2.49), and Acute Physiology and Chronic Health Evaluation II score (23.29 ± 5.31) were significantly higher than National Early Warning Score (5.29 ± 3.13), Modified Early Warning Score (3.02 ± 1.93), and Acute Physiology and Chronic Health Evaluation II score (13.22 ± 6.39) in survival group ( p < 0.01). For the disease progression evaluation, the areas under the receiver operating characteristic curves of National Early Warning Score, Modified Early Warning Score, and Acute Physiology and Chronic Health Evaluation II were 0.760, 0.729, and 0.817 ( p < 0.05), respectively, for predicting intensive care unit admission; they were 0.827, 0.723, and 0.883, respectively, for predicting 28-day mortality. The comparison of the three systems was significant ( p < 0.05). Conclusion: The performance of National Early Warning Score for predicting intensive care unit admission and 28-day mortality was inferior than Acute Physiology and Chronic Health Evaluation II but superior than Modified Early Warning Score. It was able to rapidly predict prognosis and evaluate disease progression of critical patients in resuscitation room.


2018 ◽  
Vol 27 (3) ◽  
pp. 238-242
Author(s):  
Cheryl Gagne ◽  
Susan Fetzer

Background Unplanned admissions of patients to intensive care units from medical-surgical units often result from failure to recognize clinical deterioration. The early warning score is a clinical decision support tool for nurse surveillance but must be communicated to nurses and implemented appropriately. A communication process including collaboration with experienced intensive care unit nurses may reduce unplanned transfers. Objective To determine the impact of an early warning score communication bundle on medical-surgical transfers to the intensive care unit, rapid response team calls, and morbidity of patients upon intensive care unit transfer. Methods After an early warning score was electronically embedded into medical records, a communication bundle including notification of and telephone collaboration between medical-surgical and intensive care unit nurses was implemented. Data were collected 3 months before and 21 months after implementation. Results Rapid response team calls increased nonsignificantly during the study period (from 6.47 to 8.29 per 1000 patient-days). Rapid response team calls for patients with early warning scores greater than 4 declined (from 2.04 to 1.77 per 1000 patient-days). Intensive care unit admissions of patients after rapid response team calls significantly declined (P = .03), as did admissions of patients with early warning scores greater than 4 (P = .01), suggesting that earlier intervention for patient deterioration occurred. Documented reassessment response time declined significantly to 28 minutes (P = .002). Conclusion Electronic surveillance and collaboration with experienced intensive care unit nurses may improve care, control costs, and save lives. Critical care nurses have a role in coaching and guiding less experienced nurses.


2018 ◽  
Vol 23 (6) ◽  
pp. 324-331 ◽  
Author(s):  
Rebecca J Jarden ◽  
Margaret Sandham ◽  
Richard J Siegert ◽  
Jane Koziol-McLain

2005 ◽  
Vol 11 (3) ◽  
pp. 108-117 ◽  
Author(s):  
Leanne Monterosso ◽  
Linda Kristjanson ◽  
Peter D Sly ◽  
Mary Mulcahy ◽  
Beng Gee Holland ◽  
...  

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