Quality Improvement: Implementing NEWS scores at morning board round to improve discussion of sick respiratory patients

Abstract

Aim: To improve patient flow, patients should be discussed daily as part of SAFER patient care bundle. However, the National Early Warning Score (NEWS) was seldom mentioned as a trigger for patient discussion on our SAFER board rounds, potentially missing unwell patients. Our aim was to discuss all patients with a NEWS≥4 at morning board round on our 30-bedded respiratory ward. Methods: PDSA interventions were: i) display NEWS scores on whiteboard ii) introduce ward e-observations iii) improve nursing handover of sick patients iv) display oxygen(O2) saturation 88%-92% on whiteboard. Data was collected from whiteboards, nursing handover sheets and board round discussions. Process measures were i) record of NEWS/NEWS≥4 on whiteboard, ii) record of O2 range 88%-92%, and LTOT from whiteboard/nursing sheet. Results: We performed 21 measurement cycles and 4 PDSA interventions over 4 months. Baseline(B) = daily median value of cycles 1-6, Completion(C) = daily median value of cycles 16-21. NEWS score recordings on white board (B, n=14.5: C, n=30) and NEWS≥4 recordings (B, n=1.5: C, n=6.5) both improved. O2 88%-92% recording on whiteboard (B, n=0: C, n=9.5) and nursing sheet (B, n=3: C, n=7) were also better. More sick patients were discussed at board round, (B, n=1, C, n=2.5). Board round length rose from 28 to 30.5 minutes. Conclusion: We showed an improvement in discussion of unwell respiratory patients through displaying NEWS scores during morning board round. Patients with O2 range 88%-92% may have led to inappropriate escalation of high NEWS scores. Future PDSA cycles may include introduction of oxygen focused NEWS-2 and education bundle to the ward.