Abstract
BackgroundIn 2007, the initiation of a patient safety campaign led to the introduction of Ward Observational Charts (WOC) and Medical Early Warning Score (MEWS) at Naestved Regional Hospital. This included systematic measuring of vital signs of all patients in order to prevent patient deterioration and assure timely and correct initiation of treatment. The aim of this study was to assess to what degree WOC guidelines being followed by ward staff.Design and SettingA 7-day prospective, observational, randomised, cross-sectional, point prevalence study of WOC guideline compliance in hospitalised patients on twelve wards at Naestved Hospital.ResultsThe study included 132 patients. Of these, 58% had been observed and managed correctly according to WOC guidelines. 77% had all MEWS elements recorded by staff. One patient had no MEWS elements recorded. Only 38% of patients with abnormal MEWS were correctly escalated by nursing staff. Staff was aware of the abnormal MEWS observed by investigator in 60% of the patients. Each element of WOC was on average recorded by staff in 90% of the patients.ConclusionAt the time of our study, the long-term implementation of WOC guidelines has not been completed satisfactorily. The lacking component in the implementation of MEWS and WOC is the documentation of action taken upon finding an abnormal value. Unsuccessful implementation could result in incorrect results from evaluation of an early warning system. We suggest a redesign of the training programme to educate staff in recognising and caring for critically ill patients at Naestved Hospital.
Highlights
Adverse events such as cardiac arrest, unexpected intensive care unit (ICU) admittance and unexpected death among hospitalised patients are often preceded by abnormal physiology[1,2,3,4,5,6,7,8]
58% had been observed and managed correctly according to Ward Observational Charts (WOC) guidelines. 77% had all Medical Early Warning Score (MEWS) elements recorded by staff
38% of patients with abnormal MEWS were correctly escalated by nursing staff
Summary
Adverse events such as cardiac arrest, unexpected intensive care unit (ICU) admittance and unexpected death among hospitalised patients are often preceded by abnormal physiology[1,2,3,4,5,6,7,8] This is manifested as alterations in vital signs [9]. In 2007, the initiation of a patient safety campaign led to the introduction of Ward Observational Charts (WOC) and Medical Early Warning Score (MEWS) at Naestved Regional Hospital. This included systematic measuring of vital signs of all patients in order to prevent patient deterioration and assure timely and correct initiation of treatment. The aim of this study was to assess to what degree WOC guidelines being followed by ward staff
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