How do nurses use early warning scoring systems to detect and act on patient deterioration to ensure patient safety? A scoping review

Wood, Colin; Chaboyer, Wendy; Carr, Peter

doi:10.1016/j.ijnurstu.2019.03.012

Cited by 81 publications

(99 citation statements)

References 48 publications

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“…Our findings align to other published literature, also reporting the problem of incomplete vital signs in an EHRS context (Stevenson, Israelsson, Nilsson, Petersson, & Bath, 2016). This unexpected behaviour could be the result of a lack of knowledge among nursing staff about the importance of an aggregate NEWS in determining risk, or lack of awareness of the potential consequences of not completing a thorough and timely patient assessment (Treacy & Stayt, 2019; Wood et al., 2019).…”

Section: Discussionmentioning

confidence: 99%

“…This lack of compliance has been termed “afferent limb failure” (ALF) (Johnston, Arora, King, Stroman, & Darzi, 2014; Trinkle & Flabouris, 2011). There is an abundance of literature describing the potential causes of ALF (Olsen, Søreide, Hillman, & Hansen, 2019; Treacy & Stayt, 2019; Wood, Chaboyer, & Carr, 2019) but paucity of work reporting interventions to target it (Bucknall et al., 2017; Connell et al., 2016; Duff, Massey, Gooch, & Wallis, 2018). Further, most of the interventions described are educational with methodological limitations including risks of bias and/or consistently poor detailing of the development process, suggesting that these interventions may have been developed pragmatically (i.e., based on clinician or researcher intuition) rather than using a replicable method.…”

Section: Introductionmentioning

confidence: 99%

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Patterns of behaviour in nursing staff actioning the afferent limb of the rapid response system (RRS): A focused ethnography

Smith

Cartwright

Dyson

et al. 2020

Journal of Advanced Nursing

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Aim To improve understanding of afferent limb behaviour in acute hospital ward settings, to define and specify who needs to do what differently and to report what afferent limb behaviours should be targeted in a subsequent multi‐phase, theory‐based, intervention development process. Design Focused ethnography was used including direct observation of nursing staff enacting afferent limb behaviours and review of vital signs charts. Methods An observation guide focused observation on “key moments” of the afferent limb. Descriptions of observations from between 7 January 2019–18 December 2019 were recorded in a field journal alongside reflexive notes. Vital signs and early warning scores from charts were reviewed and recorded. Field notes were analysed using structured content analysis. Observed behaviour was compared with expected (policy‐specified) behaviour. Results Observation was conducted for 300 hr. Four hundred and ninety‐nine items of data (e.g., an episode of observation or a set of vital signs) were collected. Two hundred and eighty‐nine (58%) items of data were associated with expected (i.e. policy‐specified) afferent limb behaviour; 210 (42%) items of data were associated with unexpected afferent limb behaviour (i.e. alternative behaviour or no behaviour). Ten specific behaviours were identified where the behaviour observed deviated (negatively) from policy or where no action was taken when it should have been. One further behaviour was seen to expedite the assessment of a deteriorating patient by an appropriate responder and was therefore considered a positive deviance. Conclusion Afferent limb failure has been described as a problem of inconsistent staff behaviour. Eleven potential target behaviours for change are reported and specified using a published framework. Impact Clear specification of target behaviour will allow further enquiry into the determinants of these behaviours and the development of a theory‐based intervention that is more likely to result in behaviour change and can be tested empirically in future research.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Patterns of behaviour in nursing staff actioning the afferent limb of the rapid response system (RRS): A focused ethnography

Smith

Cartwright

Dyson

et al. 2020

Journal of Advanced Nursing

View full text Add to dashboard Cite

show abstract

“…One challenge faced by the EMS is the capability of detecting risk of mortality in patients with acute diseases [14], fundamentally in time-dependent pathologies where a diagnostic or therapeutic delay may negatively influence the outcome, thereby increasing morbidity and mortality [15]. In addition, these pathologies may not be suspected or detected initially.…”

Section: Introductionmentioning

confidence: 99%

Prehospital Point-Of-Care Lactate Increases the Prognostic Accuracy of National Early Warning Score 2 for Early Risk Stratification of Mortality: Results of a Multicenter, Observational Study

Martin-Rodríguez

López-Izquierdo

Benito³

et al. 2020

JCM

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The objective of this study was to assess whether the use of prehospital lactate (pLA) can increase the prognostic accuracy of the National Early Warning Score 2 (NEWS2) to detect the risk of death within 48 h. A prospective, multicenter study in adults treated consecutively by the emergency medical services (EMS) included six advanced life support (ALS) services and five hospitals. Patients were assigned to one of four groups according to their risk of mortality (low, low-medium, medium, and high), as determined by the NEWS2 score. For each group, the validity of pLA in our cohort was assessed by the area under the curve (AUC) of the receiver operating characteristic (ROC) curve. In this study, 3081 participants with a median age of 69 years (Interquartile range (IQR): 54–81) were included. The two-day mortality was 4.4% (137 cases). The scale derived from the implementation of the pLA improved the capacity of the NEWS2 to discriminate low risk of mortality, with an AUC of 0.910 (95% CI: 0.87–0.94; p < 0.001). The risk stratification provided by the NEWS2 can be improved by incorporating pLA measurement to more accurately predict the risk of mortality in patients with low risk.

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“…Finally, our model showed good predictive performance in identifying HHC patients at risk for a UTI event. In settings other that HHC, mostly hospitals, such models are being currently used as early warning systems to inform identi cation of patients at risk [21,22]. Our results show that it is feasible to create a UTI risk model in HHC but further research is needed to implement and test this model in clinical practice.…”

Section: Discussionmentioning

confidence: 95%

Risk Factors for Urinary Tract Infection (UTI) Among Home Health Care Patients: Analysis Using Routinely Collected Clinical Data

Woo

Song

McDonald

et al. 2020

Preprint

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Abstract Background: Urinary tract infection (UTI) is a complication often experienced during a home health care (HHC) episode, yet related hospitalization risk factors are unclear. Objectives: This study use multiple data sources to identify risk factors for UTI related hospitalization or emergency department (ED) visits among HHC patients.Method: We performed a multivariable logistic regression to identify risk factors for UTI-related hospitalization or ED visits using merged data from the Outcome and Assessment Information Set, electronic health record from a large HHC agency, and Center for Medicare and Medicaid claims. Results: Of 48,336 cases, 1,689 patients (3.5%) had a UTI-related hospitalization/ED visits. Being a female (OR = 1.31; 95% CI: 1.16–1.46), the presence of a urinary catheter (OR = 5.7; 95% CI: 4.54–7.14), treatment with general antibacterial and antiseptics (OR = 2.75; 95% CI: 1.02–7.38), dependency in instrumental activities of daily living (e.g., meal preparation [OR=1.72; 95% CI: 1.25-2.37]), and no available caregivers (OR = 1.79; 95% CI: 1.2–2.68) increased the odds of a UTI related event among HHC patients. Discussion/conclusion: We identified notable risk factors for UTI related hospitalization/ER visit, filling a knowledge gap on the currently understudied HHC population. Risk factors identified in this study can be used to proactively identify HHC patients at risk for UTI related hospitalization and target them for preventive interventions. Further research is needed in HHC to develop tailored interventions for at-risk patients.

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How do nurses use early warning scoring systems to detect and act on patient deterioration to ensure patient safety? A scoping review

Abstract: How do nurses use Early warning scoring systems to detect and act on patient deterioration to ensure patient safety? A scoping reviewColin Wood a,*

Cited by 81 publications

References 48 publications

Patterns of behaviour in nursing staff actioning the afferent limb of the rapid response system (RRS): A focused ethnography

Patterns of behaviour in nursing staff actioning the afferent limb of the rapid response system (RRS): A focused ethnography

Prehospital Point-Of-Care Lactate Increases the Prognostic Accuracy of National Early Warning Score 2 for Early Risk Stratification of Mortality: Results of a Multicenter, Observational Study

Risk Factors for Urinary Tract Infection (UTI) Among Home Health Care Patients: Analysis Using Routinely Collected Clinical Data

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