Early Intervention Using the National Early Warning Scoring System for Hematological Mallignancy and HSCT Patients

Abstract

Topic Significance & Study Purpose/Background/Rationale It was identified that the systemic inflammatory response syndrome (SIRS) criteria were overly sensitive in detecting clinical deterioration the malignant hematology and cellular therapy (HMCT) population. This may create inconsistency in the activation of rapid response team (RRT) with patient decline. Objectives The aim of this project is to evaluate the implementation and use of the National Early Warning Scoring (NEWS) system in HMCT patients. The registered nurse calculates the NEWS score from the vital signs, assessment, and implements actions which may include activation of the RRT and assessment of patient for transfer to intensive care unit (ICU). Methods, Intervention, & Analysis Retrospective data collection from 2016 - 2017 was used for this project. Findings & Interpretation A statically significant decrease in the mean time between patients meeting a NEWS score of 5 or greater and activation of RRT was noted in the post-implementation group. An increase in frequency of escalation of care to the ICU for patients with multiple RRT activations during admission was statistically significant (U=296, p=0.014, r=0.31). Use of the NEWS tool has demonstrated success in identifying patients who are experiencing clinical deterioration and improved response time to initiation of additional evaluation and treatments. Discussion & Implications Use of the NEWS scoring tool results in early and consistent intervention with clinically deteriorating patients. The appropriate escalation of care to ICU setting and timely intervention with declining patients to prevent unnecessary ICU transfer is now expected in these highly vulnerable patients.