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Augutis W, Flenady T, Le Lagadec D, Jefford E. How do nurses use early warning system vital signs observation charts in rural, remote and regional health care facilities: A scoping review. Aust J Rural Health 2023. [PMID: 36802114 DOI: 10.1111/ajr.12971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 12/08/2022] [Accepted: 02/03/2023] [Indexed: 02/21/2023] Open
Abstract
INTRODUCTION Physiological signs of clinical deterioration are known to occur in the hours preceding a serious adverse event. As a result, track and trigger systems known as early warning systems (EWS) were introduced and routinely implemented as patient observation tools to trigger an alert in the presence of abnormal vital signs. OBJECTIVE The objective aimed to explore the literature pertaining to EWS and their utilisation in rural, remote and regional health care facilities. DESIGN The Arksey and O'Malley's methodological framework was used to guide the scoping review. Only studies reporting on rural, remote and regional health care settings were included. All four authors participated in the screening, data extraction and analysis process. FINDINGS Our search strategy yielded 3869 peer-reviewed articles published between 2012 and 2022, with six studies ultimately included. Collectively, the studies included in this scoping review examined the complex interaction between patient vital signs observation charts and recognition of patient deterioration. DISCUSSION Whilst rural, remote and regional clinicians use EWS to recognise and respond to clinical deterioration, noncompliance dilutes the tool's effectiveness. This overarching finding is informed by three contributing factors: documentation, communication and challenges specific to the rural context. CONCLUSION The success of EWS relies on accurate documentation and effective communication within the interdisciplinary team to support appropriate responses to clinical patient decline. More research is required to understand the nuances and complexities of rural and remote nursing and to address challenges associated with the use of EWS in rural health care settings.
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Affiliation(s)
- Wendy Augutis
- School of Nursing & Midwifery, Central Queensland University, Bundaberg, Queensland, Australia
| | - Tracy Flenady
- School of Nursing & Midwifery, Central Queensland University, Rockhampton, Queensland, Australia
| | - Danielle Le Lagadec
- School of Nursing & Midwifery, Central Queensland University, Bundaberg, Queensland, Australia
| | - Elaine Jefford
- Clinical and health Sciences, University of the Sunshine Coast, Adelaide, Queensland, Australia
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Prinsloo CJ, Jooste K. Experiences of nurses practising mindfulness during self-leadership in delivering a rapid response system for general wards in a private hospital in Gauteng. Curationis 2022; 45:e1-e9. [PMID: 35924612 PMCID: PMC9350476 DOI: 10.4102/curationis.v45i1.2298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 03/30/2022] [Accepted: 04/26/2022] [Indexed: 11/17/2022] Open
Abstract
Background The increased complexity of the nursing care needs of patients and acuity in general wards present nursing care challenges for nurses. Self-led nurses are attentive, taking responsibility for activating the rapid response service when a patient is starting to deteriorate. Objectives The purpose of this article is to describe nurses’ experiences practising mindfulness during self-leadership in delivering a rapid response system (RRS) in a private hospital in Gauteng. Method A qualitative, exploratory, descriptive and contextual design was followed. Homogenous purposive sampling was used and a total of eight focus groups were conducted. Focus groups durations were between 45 min and 60 min. The data analysis was carried out through open coding on Atlas.ti using the noticing things, collecting things and thinking about things (NCT) approach. An independent coder met with the researcher during a consensus meeting and finalised the analysis. Results The findings indicated an underlying theme of nurses being mindful in their self-leadership through the development of self-motivation and self-direction in the RRS. Three categories with six subcategories emerged from the data analysis, namely self-motivation in an RRS by the team, self-direction through role-modelling to peers and training. Conclusion Nurses practised mindfulness during self-leadership, utilising behavioural and natural reward approaches and constructive thought patterns. These findings could assist management with developing training programmes for nurses.
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Affiliation(s)
- Carine J Prinsloo
- School of Nursing, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa; and, Department of Health Studies, College of Humanities, University of South Africa, Pretoria.
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Patient Deterioration on General Care Units: A Concept Analysis. ANS Adv Nurs Sci 2022; 45:E56-E68. [PMID: 34879020 DOI: 10.1097/ans.0000000000000396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Patient deterioration is a phenomenon that occurs from the inability to recognize it or respond to a change in condition. Despite the published reports on recognizing a deteriorating patient on general care floors, a gap remains in the ability of nurses to describe the concept, affecting patient outcomes. Walker and Avant's approach was applied to analyze patient deterioration. The aim of this article was to explore and clarify the meaning of patient deterioration and identify attributes, antecedents, and consequences. The defining attributes were compared to early warning scores. An operational definition was developed and its value to nurses established.
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Qualls BW, Bode AM, Hopkins KR. Deviation in Medical Record Documentation Prevents Calculation of the Modified Early Warning System Score. Prof Case Manag 2022; 27:100-104. [PMID: 35099426 DOI: 10.1097/ncm.0000000000000557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Brandon W Qualls
- Brandon W. Qualls, MPA, is the Coordinator of the Clinical Nursing Research Center and a PhD student at the Margaret Warner Graduate School of Education and Human Development at the University of Rochester, Rochester, NY. Brandon received both his undergraduate and master's degrees from The College at Brockport, State University of New York (SUNY)
- Angela M. Bode, BSN, CMSRN , is a clinical resource administrator at Highland Hospital and a family nurse practitioner student at St. John Fisher College, Highland Hospital, Rochester, NY
- Kathryn R. Hopkins, BSN, RN, is a staff nurse, Cardiovascular Intensive Care Unit, Thomas Jefferson University Hospital, Philadelphia, PA
| | - Angela M Bode
- Brandon W. Qualls, MPA, is the Coordinator of the Clinical Nursing Research Center and a PhD student at the Margaret Warner Graduate School of Education and Human Development at the University of Rochester, Rochester, NY. Brandon received both his undergraduate and master's degrees from The College at Brockport, State University of New York (SUNY)
- Angela M. Bode, BSN, CMSRN , is a clinical resource administrator at Highland Hospital and a family nurse practitioner student at St. John Fisher College, Highland Hospital, Rochester, NY
- Kathryn R. Hopkins, BSN, RN, is a staff nurse, Cardiovascular Intensive Care Unit, Thomas Jefferson University Hospital, Philadelphia, PA
| | - Kathryn R Hopkins
- Brandon W. Qualls, MPA, is the Coordinator of the Clinical Nursing Research Center and a PhD student at the Margaret Warner Graduate School of Education and Human Development at the University of Rochester, Rochester, NY. Brandon received both his undergraduate and master's degrees from The College at Brockport, State University of New York (SUNY)
- Angela M. Bode, BSN, CMSRN , is a clinical resource administrator at Highland Hospital and a family nurse practitioner student at St. John Fisher College, Highland Hospital, Rochester, NY
- Kathryn R. Hopkins, BSN, RN, is a staff nurse, Cardiovascular Intensive Care Unit, Thomas Jefferson University Hospital, Philadelphia, PA
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Campbell V, Conway R, Carey K, Tran K, Visser A, Gifford S, McLanders M, Edelson D, Churpek M. Predicting clinical deterioration with Q-ADDS compared to NEWS, Between the Flags, and eCART track and trigger tools. Resuscitation 2020; 153:28-34. [PMID: 32504769 PMCID: PMC7896199 DOI: 10.1016/j.resuscitation.2020.05.027] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 05/15/2020] [Accepted: 05/20/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Early warning tools have been widely implemented without evidence to guide (a) recognition and (b) response team expertise optimisation. With growing databases from MET-calls and digital hospitals, we now have access to guiding information. The Queensland Adult-Deterioration-Detection-System (Q-ADDS) is widely used and requires validation. AIM Compare the accuracy of Q-ADDS to National Early Warning Score (NEWS), Between-the-Flags (BTF) and the electronic Cardiac Arrest Risk Triage Score (eCART)). METHODS Data from the Chicago University hospital database were used. Clinical deterioration was defined as unplanned admission to ICU or death. Currently used NEWS, BTF and eCART trigger thresholds were compared with a clinically endorsed Q-ADDS variant. RESULTS Of 224,912 admissions, 11,706 (5%) experienced clinical deterioration. Q-ADDS (AUC 0.71) and NEWS (AUC 0.72) had similar predictive accuracy, BTF (AUC 0.64) had the lowest, and eCART (AUC 0.76) the highest. Early warning alert (advising ward MO review) had similar NPV (99.2-99.3%), for all the four tools however sensitivity varied (%: Q-ADDS = 47/NEWS = 49/BTF = 66/eCART = 40), as did alerting rate (% vitals sets: Q-ADDS = 1.4/NEWS = 3.5/BTF = 4.1/eCART = 3.4). MET alert (advising MET/critical-care review) had similar NPV for all the four tools (99.1-99.2%), however sensitivity varied (%: Q-ADDS = 14/NEWS = 24/BTF = 19/eCART = 29), as did MET alerting rate (%: Q-ADDS = 1.4/NEWS = 3.5/BTF = 4.1/eCART = 3.4). High-severity alert (advising advanced ward review, Q-ADDS only): NPV = 99.1%, sensitivity = 26%, alerting rate = 3.5%. CONCLUSION The accuracy of Q-ADDS is comparable to NEWS, and higher than BTF, with eCART being the most accurate. Q-ADDS provides an additional high-severity ward alert, and generated significantly fewer MET alerts. Impacts of increased ward awareness and fewer MET alerts on actual MET call numbers and patient outcomes requires further evaluation.
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Affiliation(s)
- Victoria Campbell
- Intensive Care Unit, Sunshine Coast University Hospital, Queensland, Australia.
| | - Roger Conway
- Deteriorating Patient Response, Sunshine Coast University Hospital, Queensland, Australia.
| | - Kyle Carey
- Department of Medicine, University of Chicago, Chicago, IL, United States.
| | - Khoa Tran
- Logan Hospital, Queensland, Australia.
| | - Adam Visser
- Intensive Care Unit, Toowoomba Hospital, Queensland, Australia.
| | - Shaune Gifford
- Patient Safety and Quality Improvement Service, Clinical Excellence Queensland, Australia.
| | - Mia McLanders
- Patient Safety and Quality Improvement Service, Clinical Excellence Queensland, Australia; School of Psychology, The University of Queensland, Australia.
| | - Dana Edelson
- Department of Medicine, University of Chicago, Chicago, IL, United States.
| | - Matthew Churpek
- Department of Medicine, University of Chicago, Chicago, IL, United States.
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Porter JE, Peck B, McNabb TJ, Missen K. A review of Code Blue activations in a single Regional Australian Healthcare Service: A retrospective descriptive study of RISKMAN data. J Clin Nurs 2019; 29:221-227. [PMID: 31633855 DOI: 10.1111/jocn.15079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 06/03/2019] [Accepted: 08/04/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND In the case of life-threatening conditions such as respiratory or cardiac arrest, or the clinical deterioration of the patient, a Code Blue activation may be instigated. A Code Blue activation involves a team of advanced trained clinicians attending the emergency needs of the patient. AIMS AND OBJECTIVES The aim of the study was to explore the number of cases of Code Blue activations, looking at the timing, clinical ward, diagnosis and activation criteria while noting cases where escalation from a Medical Emergency Team (MET) call occurs in one Regional Healthcare Service in Victoria, Australia, over a six-year period. METHODS A quantitative retrospective descriptive study of Code Blue emergencies over a six-year period from June 2010 to June 2016 was conducted. Data collected from the RISKMAN program operating at a single site was imported into SPSS (V 22) for descriptive statistical analysis. A STROBE EQUATOR checklist was used for this study (see File S1). FINDINGS The majority of Code Blue activations were male (59%, n = 127) and aged between 70 and 89 years of age (43%, n = 93). A Code Blue activation was more likely to occur at 08:00 hr, 14:00 hr or 22:00 hr, corresponding to the nurses' change in shift, with the majority of Code Blues (27.8%, n = 60) occurring in the emergency department. Cardiac arrest was the main activation criterion with 54.6% (n = 118) cases followed by respiratory arrest (14%, n = 32). Interestingly, 20% (n = 45) of the Code Blue activations were upgraded from a Medical Emergency Team (MET) call. CONCLUSION This project has produced several interesting findings surrounding Code Blue activations at one regional healthcare service which are not present in existing literature and is worthwhile for further investigation. RELEVANCE TO CLINICAL PRACTICE Understanding Code Blue activation criteria, common timings (month, time of day) and patient demographics ensures clinicians can remain vigilant in watching for the signs of patient deterioration and improve staff preparedness Code Blue events.
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Affiliation(s)
- Joanne E Porter
- School of Nursing and Healthcare Professions, Federation University Australia, Ballarat, Vic, Australia
| | - Blake Peck
- School of Nursing and Healthcare Professions, Federation University Australia, Ballarat, Vic, Australia
| | - Tiffinee J McNabb
- School of Nursing and Healthcare Professions, Federation University Australia, Ballarat, Vic, Australia
| | - Karen Missen
- School of Nursing and Healthcare Professions, Federation University Australia, Ballarat, Vic, Australia
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Taylor A, Broadbent M, Wallis M, Marsden E. The predictive validity of the interRAI ED screener for predicting re-presentation within 28 days for older adults at a regional hospital emergency department. Australas Emerg Care 2019; 22:149-155. [DOI: 10.1016/j.auec.2019.04.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 04/14/2019] [Accepted: 04/24/2019] [Indexed: 11/26/2022]
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Wood C, Chaboyer W, Carr P. How do nurses use early warning scoring systems to detect and act on patient deterioration to ensure patient safety? A scoping review. Int J Nurs Stud 2019; 94:166-178. [DOI: 10.1016/j.ijnurstu.2019.03.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 03/17/2019] [Accepted: 03/18/2019] [Indexed: 10/27/2022]
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Le Lagadec MD, Dwyer T, Browne M. The efficacy of twelve early warning systems for potential use in regional medical facilities in Queensland, Australia. Aust Crit Care 2019; 33:47-53. [PMID: 30979578 DOI: 10.1016/j.aucc.2019.03.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 02/05/2019] [Accepted: 03/06/2019] [Indexed: 10/27/2022] Open
Abstract
AIM Early warning system (EWS) validation studies are conducted predominantly in tertiary metropolitan facilities and are not necessarily applicable to regional hospitals. This study evaluates 12 EWSs for use in regional subcritical hospitals. METHOD This is a retrospective case-control study of patients who experienced severe adverse events (SAEs) in two regional private hospitals. Vital signs collected over 72 h preceding the SAE were applied to 12 EWSs representing three classes of EWSs. The EWS area under the receiver operator characteristic curve (AUROC), sensitivity, specificity, and number of alerts were calculated. RESULTS Data from 159 index and 172 control patients showed no significant differences in demographics, length of stay, and level of comorbidities. Only half of index patients achieved a medical emergency alert threshold score. On average, index patients triggered alerts 20.06 (22.67) hours preceding the SAE and alerted 2.25 (3.87) times over 72 h. The AUROC ranged from 0.628 to 0.747, with a single-parameter EWS having the lowest AUROC and an aggregated weighted EWS, the highest. The sensitivity of the EWS ranges from 0.359 to 0.692. The specificity was greater than 0.9 for all the EWSs tested. CONCLUSIONS Based on the EWS sensitivity and AUROC, there is a lack of conclusive evidence of the efficacy of the 12 EWSs tested. However, because the adoption of the EWS in Australian hospitals is mandatory, the implementation of an aggregated weighted EWS, such as Compass, should be considered in subcritical regional private hospitals. Given that only half of SAE achieved an EWS medical alert threshold score, it is important that good clinical judgement be used with EWS.
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Affiliation(s)
| | - Trudy Dwyer
- CQUniversity Australia, Building 18/G.06 Rockhampton, Bruce Highway, Rockhampton Qld, 4702 Australia.
| | - Matthew Browne
- CQUniversity Australia, University Drive, Building 8/G.47 Bundaberg, Branyan Australia, Qld, 4670, Australia.
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