Abstract
AimsTo explore Registered Nurses' experiences and perceptions with National Early Warning Score and Individual Early Warning Score to identify patient deterioration.DesignA qualitative exploratory design.MethodsSix focus groups were conducted at six Danish hospitals from February to June 2019. Registered Nurses from both medical, surgical and emergency departments participated. The focus groups were analysed using content analysis.ResultsOne theme and four categories were identified. Theme: Meaningful in identifying patient deterioration but causing frustration due to lack of flexibility. Categories: (a) Inter‐professional collaboration strengthened through the use of Early Warning Score systems, (b) Enhanced professional development and communication among nurses when using Early Warning Score systems, (c) Detecting patient deterioration by integrating nurses' clinical gaze with Early Warning Score systems and (d) Modification and fear of making mistakes when using Early Warning Score systems.
Highlights
Deterioration is a risk to all in-hospital patients and includes the risk of suffering a serious adverse event (SAE) such as cardiac arrest, unplanned admission for intensive care, and unexpected death
Three of the focus groups were conducted at hospitals using I-Early Warning Score (EWS), two were conducted at hospitals using National Early Warning Score (NEWS) and the last one was conducted at a hospital where they had returned to NEWS after using Individual Early Warning Score (I-EWS)
Warning Score systems were in this study showed to be meaningful to Registered Nurses (RNs) in identifying patient deterioration
Summary
Deterioration is a risk to all in-hospital patients and includes the risk of suffering a serious adverse event (SAE) such as cardiac arrest, unplanned admission for intensive care, and unexpected death. The majority (84%) of patients have abnormal vital signs prior to SAE, suggesting that some can be prevented if abnormal vital signs are detected and acted upon by clinicians (Kause et al, 2004). Warning Score (EWS) systems comprise a tool for scoring vital signs and an escalation protocol. EWS systems have been implemented in healthcare systems worldwide to support the detection of abnormal vital signs and thereby help clinicians prevent patient deterioration. The danger when using EWS systems is over-relying on the system instead of using it as an aid or supplement to clinical assessment (Grant, 2019). Over-reliance on the system has established a culture where monitoring vital signs are ritualistic and task-oriented, and compliance with EWS systems is poor (Credland et al, 2018). Even though EWS systems are well established in many healthcare systems, continuous optimization and development of these systems are essential to support patient safety in healthcare systems that are constantly changing
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