C J Yiu, S U Khan, C P Subbe1, K Tofeec, R A Madge. 1. Consultant in Acute Medicine, Respiratory & Critical Care Medicine, Ysbyty Gwynedd, United Kingdom and Senior Clinical Lecturer, School of Medical Sciences, Bangor University, Bangor, UK.
Abstract
BACKGROUND: Early Warning Scores alert staff to preventable deterioration. Raised scores should lead to escalation of care. AIMS: To establish response of staff to patients scoring National Early Warning Score (NEWS) of six or above and to identify patient and environmental factors affecting escalation by nursing staff. METHODS: Service evaluation with prospective review of patient records of 118 beds on four medical wards during 20 night-shifts. RESULTS: During 2360 observed bed days 109 patients triggered NEWS>=6 at least once during the observation period. Nursing staff escalated only 18 (17%) of these patients; nearly all of them had predefined chronic health conditions, the majority fulfilled criteria for frailty. Despite their higher 30-day mortality patients with COPD had lower escalation rates. Additionally wards that had more patients with a NEWS>=6 had lower escalation rates. CONCLUSION: Alarm fatigue and clinical judgement of staff might result in deviation from escalation protocols.
BACKGROUND: Early Warning Scores alert staff to preventable deterioration. Raised scores should lead to escalation of care. AIMS: To establish response of staff to patients scoring National Early Warning Score (NEWS) of six or above and to identify patient and environmental factors affecting escalation by nursing staff. METHODS: Service evaluation with prospective review of patient records of 118 beds on four medical wards during 20 night-shifts. RESULTS: During 2360 observed bed days 109 patients triggered NEWS>=6 at least once during the observation period. Nursing staff escalated only 18 (17%) of these patients; nearly all of them had predefined chronic health conditions, the majority fulfilled criteria for frailty. Despite their higher 30-day mortality patients with COPD had lower escalation rates. Additionally wards that had more patients with a NEWS>=6 had lower escalation rates. CONCLUSION: Alarm fatigue and clinical judgement of staff might result in deviation from escalation protocols.
Authors: Christian P Subbe; John Kellett; Paul Barach; Catriona Chaloner; Hayley Cleaver; Tim Cooksley; Erik Korsten; Eilish Croke; Elinor Davis; Ashley Jr De Bie; Lesley Durham; Chris Hancock; Jilian Hartin; Tracy Savijn; John Welch Journal: BMC Health Serv Res Date: 2017-05-08 Impact factor: 2.655