Abstract
BackgroundThe early warning score (EWS) was developed to identify deteriorating patients early. It is a track-and-trigger system based on vital signs designed to direct appropriate clinical responses based on the seriousness and nature of the underlying condition. Despite its wide dissemination, serious adverse events still occur, often due to failure among staff on general wards to follow the EWS protocol. The purpose of the study was to determine barriers and facilitating factors related to three aspects of the EWS protocol: 1) adherence to monitoring frequency, 2) call for junior doctors to patients with an elevated EWS, and 3) call for the medical emergency team.MethodsFocus groups were conducted with nurses from medical and surgical acute care wards, and content analysis was used to identify barriers and facilitating factors in relation to the research questions.ResultsAdherence to monitoring frequency would frequently be set aside during busy periods for other tasks. Collaboration and communication with doctors about medical patients with elevated EWS was considered to be unrealistic due to the high number of patients with these scores. Collaboration with the medical emergency team was problematic, since many nurses found the team to have negative attitudes.ConclusionEWS reduces complex clinical conditions to a single number, with the inherent risk to overlook clinical cues and subtle changes in patients’ condition. The study showed that identifying and treating deteriorating patients is a collaborative task that requires diverse technical and non-technical skills for staff to perform optimally.
Highlights
The early warning score (EWS) was developed to identify deteriorating patients early
A total of five focus group interviews were conducted from July 20 to October 29, 2014 with 3 to 5 participants in each
Research question 1: What are the barriers and facilitating factors in relation to adhering to monitoring frequency? Two forms of non-adherence to monitoring frequency emerged during the interviews: over-monitoring, i.e. monitoring more frequently than per protocol, was primarily described in positive terms, while undermonitoring generally was viewed as objectionable and considered bad nursing practice, but reported to occur frequently during busy periods
Summary
The early warning score (EWS) was developed to identify deteriorating patients early It is a track-andtrigger system based on vital signs designed to direct appropriate clinical responses based on the seriousness and nature of the underlying condition. The early warning score (EWS) was developed as an aid for general ward staff to detect deterioration [3]. It is based on a set of routinely measured vital signs (Table 1) and clinical triggers to direct staff as to Petersen et al BMC Emergency Medicine (2017) 17:36 Vital sign.
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