None listed
Conditions
Brief summary
There is growing concern about and awareness of the failure to recognise and appropriately manage deteriorating patients on the wards in hospitals. The consequence of not managing these deteriorating patients is evidenced by unplanned ICU admissions and in-hospital deaths. In April 2010, the Australian Commission on Safety and Quality in Health Care released a National Consensus statement on the essential elements to recognising and responding to clinical deterioration. Royal Darwin Hospital (RDH) is preparing to implement a multifaceted intervention to comply with these national recommendations. New ward observation charts will be introduced to two wards at RDH which will allow the recording of a modified early warning score (MEWS). High scores will automatically trigger the nurse at the bedside to call an appropriately qualified medical practitioner for a timely review of the patient and initiate earlier management. The roll out of this system will be preceded by a period of education for nursing and medical staff using the COMPASS program. I will review the use of MEWS observation charts and the morbidity and mortality of patients before and after this intervention on two wards at RDH.
Interventions
Implementation of a modified early warning score (MEWS) observation chart on intervention wards preceded by a period of education using the COMPASS program.
(A) Modified Early Warning Score Observation Chart is a new ward observation chart where respiratory rate, oxygen saturation, temperature, blood pressure, heart rate, sedation and urine output are all documented. The observations form the y-axis and time forms the x-axis. These observations are represented graphically and numerically on a
Implementation of a modified early warning score (MEWS) observation chart on intervention wards preceded by a period of education using the COMPASS program. (A) Modified Early Warning Score Observation Chart is a new ward observation chart where respiratory rate, oxygen saturation, temperature, blood pressure, heart rate, sedation and urine output are all documented. The observations form the y-axis and time forms the x-axis. These observations are represented graphically and numerically on a discrete area of on the y-axis, except for blood pressure and heart rate which are on the same scale. Each observation done corresponds to MEWS value (0-3) which is colour coded and documented on the chart. At the bottom of the MEWS chart is an area for total MEWS score which adds up the individual MEWS scores for all 7 vital signs. The total MEWS score then corresponds to an escalation protocol. (B/C/D) The Education session for the COMPASS program involves the following: (1) An interactive CD ROM containing information on the basic physiological principles underlying vital signs, example observation charts of deteriorating patients and questions related to abnormal observations. (2) A 100 page education manual: Containing a comprehensive package on physiological principles underlying vital signs, “ABC” and deteriorating patients, the use of Modified Early Warning Scores and communication strategies and enhancement of team work. (3) Assessment using a multiple choice quiz. The CD and quiz is to be done in each staff member's own time, however a cut off date to have the quiz completed is established on each ward by the nurse in charge. (4) A 2-3 hour face-to-face teaching session where practical instructions on the use of modified early warning score and practical instructions of communication strategy are taught. Multiple sessions are held leading up to the implementation of MEWS charts on each ward, and each staff member must attend one session. (E) The duration of the intervention period in which I am auditing is one month, however MEWS charts are being rolled out throughout the Royal Darwin Hospital on a permanent basis.
Sponsors
Royal Darwin Hospital
Study design
Allocation
Non-randomised trial
Intervention model
Single group
Primary purpose
Prevention
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
All patients over 18 years of age admitted to the two intervention wards
Exclusion criteria
Palliative Care patients
Outcome results
None listed