Development of a Standardized System to Detect and Treat Early Patient Deterioration.
Journal
Journal of nursing care quality
ISSN: 1550-5065
Titre abrégé: J Nurs Care Qual
Pays: United States
ID NLM: 9200672
Informations de publication
Date de publication:
Historique:
pubmed:
14
4
2020
medline:
17
8
2021
entrez:
14
4
2020
Statut:
ppublish
Résumé
Inpatient nurses identified the need to recognize clinical deterioration earlier, including rapid response team (RRT) activations and transfers to the intensive care unit. Surveys identified the need for better interdisciplinary communication. A system was needed to detect early clinical deterioration with structured responses promoting multidisciplinary collaboration. An early warning score (EWS) identified patients at risk. The system ensured timely and accurate actions were taken when scores reached 3 or above. Collaborative, graded responses to EWSs and nurse-led rounds promoted communication and timely interventions. Mortality decreased (-27%) as did multiple RRT activations on a single patient (-15%). Nurses are aware of early vital sign changes (+45%) and resident responsiveness has improved. There has been an increase in nurse/resident communication satisfaction (+31%). The system implemented reinforces the importance of patient assessment, collaboration among the multidisciplinary team, and promotes early interventions.
Sections du résumé
BACKGROUND
BACKGROUND
Inpatient nurses identified the need to recognize clinical deterioration earlier, including rapid response team (RRT) activations and transfers to the intensive care unit. Surveys identified the need for better interdisciplinary communication.
LOCAL PROBLEM
OBJECTIVE
A system was needed to detect early clinical deterioration with structured responses promoting multidisciplinary collaboration.
METHODS
METHODS
An early warning score (EWS) identified patients at risk. The system ensured timely and accurate actions were taken when scores reached 3 or above.
INTERVENTIONS
METHODS
Collaborative, graded responses to EWSs and nurse-led rounds promoted communication and timely interventions.
RESULTS
RESULTS
Mortality decreased (-27%) as did multiple RRT activations on a single patient (-15%). Nurses are aware of early vital sign changes (+45%) and resident responsiveness has improved. There has been an increase in nurse/resident communication satisfaction (+31%).
CONCLUSIONS
CONCLUSIONS
The system implemented reinforces the importance of patient assessment, collaboration among the multidisciplinary team, and promotes early interventions.
Identifiants
pubmed: 32282504
pii: 00001786-202101000-00006
doi: 10.1097/NCQ.0000000000000484
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
32-37Informations de copyright
Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
The authors declare no conflicts of interest.
Références
Prytherch DR, Smith GB, Schmidt PE, Featherstone PI. ViEWS—towards a national early warning score for detecting adult inpatient deterioration. Resuscitation. 2010;81(8):932–937.
Le Lagadec MD, Dwyer T. Scoping review: the use of early warning systems for the identification of in-hospital patients at risk of deterioration. Aust Crit Care. 2017;30(4):211–218.
Fox A, Elliott N. Early warning scores: a sign of deterioration in patients and systems. Nurs Manag. 2015;22(1):26–31.
McGloin H, Adam SK, Singer M. Are some unexpected hospital deaths avoidable? Nurs Stand. 1999;13(44):10–10.
Maftoohian M, Assarroudi A, Stewart JJ, Dastani M, Rakhshani MH, Sahebkar M. Evaluating the use of a modified early warning score in predicting serious adverse events in Iranian hospitalized patients: a prognostic study. J Emerg Nurs. 2020;46(1):72–82.
Subbe CP, Welch JR. Failure to rescue: using rapid response systems to improve care of the deteriorating patient in hospital. Clin Risk. 2013;19(1):6–11.
Downey CL, Tahir W, Randell R, Brown JM, Jayne DG. Strengths and limitations of early warning scores: a systematic review and narrative synthesis. Int J Nurs Stud. 2017;76:106–119.
Schein RM, Hazday N, Pena M, Ruben BH, Sprung CL. Clinical antecedents to in-hospital cardiopulmonary arrest. Chest. 1990;98(6):1388–1392.
Bhattacharjee P, Edelson DP, Churpek MM. Identifying patients with sepsis on the hospital wards. Chest. 2017;151(4):898–907.
Dunn KL, Reddy P, Moulden A, Bowes G. Medical record review of deaths, unexpected intensive care unit admissions, and clinician referrals: detection of adverse events and insight into the system. Arch Dis Child. 2006;91(2):169–172.
Treacy M, Stayt LC. To identify the factors that influence the recognizing and responding to adult patient deterioration in acute hospitals. J Adv Nurs. 2019;75(12):3272–3285.
Ludikhuize J, Smorenburg SM, de Rooij SE, de Jonge E. Identification of deteriorating patients on general wards; measurement of vital parameters and potential effectiveness of the modified early warning score. J Crit Care. 2012;27(4):424.e7–e13.