Background In 2007, the initiation of a patient safety campaign led to the introduction of Ward Observational Charts (WOC) and Medical Early Warning Score (MEWS) at Naestved Regional Hospital. This included systematic measuring of vital signs of all patients in order to prevent patient deterioration and assure timely and correct initiation of treatment. The aim of this study was to assess to what degree WOC guidelines being followed by ward staff. Design and Setting A 7-day prospective, observational, randomised, cross-sectional, point prevalence study of WOC guideline compliance in hospitalised patients on twelve wards at Naestved Hospital. Results The study included 132 patients. Of these, 58% had been observed and managed correctly according to WOC guidelines. 77% had all MEWS elements recorded by staff. One patient had no MEWS elements recorded. Only 38% of patients with abnormal MEWS were correctly escalated by nursing staff. Staff was aware of the abnormal MEWS observed by investigator in 60% of the patients. Each element of WOC was on average recorded by staff in 90% of the patients. Conclusion At the time of our study, the long-term implementation of WOC guidelines has not been completed satisfactorily. The lacking component in the implementation of MEWS and WOC is the documentation of action taken upon finding an abnormal value. Unsuccessful implementation could result in incorrect results from evaluation of an early warning system. We suggest a redesign of the training programme to educate staff in recognising and caring for critically ill patients at Naestved Hospital.
References
[1]
Buist M, Bernard S, Nguyen TV, Moore G, Anderson J (2004) Association between clinically abnormal observations and subsequent in-hospital mortality: a prospective study. Resuscitation 62: 137–141 doi:10.1016/j.resuscitation.2004.03.005.
[2]
Franklin C, Mathew J (1994) Developing strategies to prevent inhospital cardiac arrest: analyzing responses of physicians and nurses in the hours before the event. Crit Care Med 22: 244–247.
[3]
Fuhrmann L, Lippert A, Perner A, Ostergaard D (2008) Incidence, staff awareness and mortality of patients at risk on general wards. Resuscitation 77: 325–330 doi:10.1016/j.resuscitation.2008.01.009.
[4]
Hillman KM, Bristow PJ, Chey T, Daffurn K, Jacques T, et al. (2001) Antecedents to hospital deaths. Intern Med J 31: 343–348.
[5]
Kause J, Smith G, Prytherch D, Parr M, Flabouris A, et al. (2004) A comparison of antecedents to cardiac arrests, deaths and emergency intensive care admissions in Australia and New Zealand, and the United Kingdom–the ACADEMIA study. Resuscitation 62: 275–282 doi:10.1016/j.resuscitation.2004.05.016.
[6]
Nurmi J, Harjola VP, Nolan J, Castrén M (2005) Observations and warning signs prior to cardiac arrest. Should a medical emergency team intervene earlier? Acta Anaesthesiol Scand 49: 702–706 doi:–10.1111/j.1399–6576.2005.00679.x.
[7]
Smith AF, Wood J (1998) Can some in-hospital cardio-respiratory arrests be prevented? A prospective survey. Resuscitation 37: 133–137.
[8]
Hillman KM, Bristow PJ, Chey T, Daffurn K, Jacques T, et al. (2002) Duration of life-threatening antecedents prior to intensive care admission. Intensive Care Med 28: 1629–1634 doi:––10.1007/s00134–002–1496-y.
[9]
Jacques T, Harrison GA, McLaws M-L, Kilborn G (2006) Signs of critical conditions and emergency responses (SOCCER): a model for predicting adverse events in the inpatient setting. Resuscitation 69: 175–183 doi:10.1016/j.resuscitation.2005.08.015.
[10]
Fuhrmann L, Hesselfeldt R, Lippert A, Perner A, Ostergaard D (2009) [Observation of critically ill patients]. Ugeskr Laeg 171: 502–506.
[11]
Buist MD, Moore GE, Bernard SA, Waxman BP, Anderson JN, et al. (2002) Effects of a medical emergency team on reduction of incidence of and mortality from unexpected cardiac arrests in hospital: preliminary study. BMJ 324: 387–390.
[12]
Bellomo R, Goldsmith D, Uchino S, Buckmaster J, Hart GK, et al. (2003) A prospective before-and-after trial of a medical emergency team. Med J Aust 179: 283–287.
[13]
Hillman K, Chen J, Cretikos M, Bellomo R, Brown D, et al. (2005) Introduction of the medical emergency team (MET) system: a cluster-randomised controlled trial. Lancet 365: 2091–2097 doi:––10.1016/S0140–6736(05)66733–5.
[14]
Jones D, Bellomo R, Bates S, Warrillow S, Goldsmith D, et al. (2005) Long term effect of a medical emergency team on cardiac arrests in a teaching hospital. Crit Care 9: R808–R815 doi:10.1186/cc3906.
[15]
The Cochrane Collaboration, McGaughey J, editors (1996) Cochrane Database of Systematic Reviews. John Wiley & Sons, Ltd. Chichester, UK: John Wiley & Sons, Ltd. doi: 10.1002/14651858.CD005529.pub2.
[16]
Laurens NH, Dwyer TA (2010) The effect of medical emergency teams on patient outcome: a review of the literature. Int J Nurs Pract 16: 533–544 doi:–××10.1111/j.1440–172×2010.01879×.
[17]
Laurens N, Dwyer T (2011) The impact of medical emergency teams on ICU admission rates, cardiopulmonary arrests and mortality in a regional hospital. Resuscitation 82: 707–712 doi:10.1016/j.resuscitation.2010.11.031.
[18]
Mitchell IA, McKay H, Van Leuvan C, Berry R, McCutcheon C, et al. (2010) A prospective controlled trial of the effect of a multi-faceted intervention on early recognition and intervention in deteriorating hospital patients. Resuscitation 81: 658–666 doi:10.1016/j.resuscitation.2010.03.001.
[19]
Urbaniak G, Plous S (2012) Research Randomizer (Version 3.0)[Computer software]. Retrieved on March 17, 2012, from http://www.randomizer.org/.
[20]
Carey R (2003) Improving healthcare with control charts: basic and advanced SPC methods and Case studies. 1st ed.
[21]
Considine J (2005) The role of nurses in preventing adverse events related to respiratory dysfunction: literature review. J Adv Nurs 49: 624–633 doi:–10.1111/j.1365–2648.2004.03337.x.
[22]
Smith GB, Osgood VM, Crane S (2002) ALERT–a multiprofessional training course in the care of the acutely ill adult patient. Resuscitation 52: 281–286.
[23]
Odell M, Victor C, Oliver D (2009) Nurses’ role in detecting deterioration in ward patients: systematic literature review. J Adv Nurs 65: 1992–2006.
[24]
Oakey RJ, Slade V (2006) Physiological observation track and trigger system. Nurs Stand 20: 48–54.
[25]
Prytherch DR, Smith GB, Schmidt P, Featherstone PI, Stewart K, et al. (2006) Calculating early warning scores–a classroom comparison of pen and paper and hand-held computer methods. Resuscitation 70: 173–178 doi:10.1016/j.resuscitation.2005.12.002.
[26]
Mohammed M, Hayton R, Clements G, Smith G, Prytherch D (2009) Improving accuracy and efficiency of early warning scores in acute care. Br J Nurs 18: 18–24.
[27]
Prytherch DR, Smith GB, Schmidt PE, Featherstone PI (2010) ViEWS–Towards a national early warning score for detecting adult inpatient deterioration. Resuscitation 81: 932–937 doi:10.1016/j.resuscitation.2010.04.014.
[28]
Jones S, Mullally M, Ingleby S, Buist M, Bailey M, et al. (2011) Bedside electronic capture of clinical observations and automated clinical alerts to improve compliance with an Early Warning Score protocol. Crit Care Resusc 13: 83–88.
