Early Warning Systems – A study into the determination of accuracy and Protocol compliance - Jan McMeekin

Early Warning Systems – A study into the determination of accuracy and Protocol compliance
A study by
Pamela Munro, Consultant Nurse, Critical Care
Amor Padala, Nurse Practitioner, Critical Care
Whipps Cross University Hospital
Presented by Jan McMeekin, Welch Allyn

Transcript

1. Early Warning Systems – A study into the determination of accuracy and Protocol compliance A study by Pamela Munro, Consultant Nurse, Critical Care Amor Padala, Nurse Practitioner, Critical Care Whipps Cross University Hospital Presented by Jan McMeekin, Welch Allyn
2. • Failure to rescue deteriorating patients is an area of significant unintended harm • ‘Track and Trigger’ systems introduced to help overcome this – Utilising an increase in clinical vigilance which includes increase in physiological monitoring • Accuracy of the data collected and adherence to the protocols is essential to the success of such a system Background to Study
3. • To assess accuracy of charting of observation round data and adherence to EWS protocols • Setting – Acute medical and surgical ward in DGH • Evaluation assessed vital signs recording in two ways – Standard manual recording – Automated collection Aim of Study
4. • Collection of patient’s vital signs performed by healthcare worker (HW) • Data transferred manually to paper observation chart (normal practice) and EWS risk band calculated and recorded • Nurse Evaluator (NE) observed process and recorded vital signs data and EWS risk band as provided by HW onto Case Report From • Data also sent electronically into Connex System • Comparison of the two sets of data undertaken by statistician Method
5. • 44 Healthcare Workers participated • Data collected – Systolic and diastolic Blood Pressure (SBP) (DBP) – Mean arterial pressure (MAP) – Pulse rate – Temperature – Oxygen saturation (SpO2 ) • 243 sets of data included in the Study Results Staff nurses – 16 Junior Sisters – 5 Student nurses – 13 Healthcare Assts - 9
6. • Omission rate (%O) and Error Rate (%E) compared between the two collection methods Omission and Error Rates VS HW %O Connex %O p-value HW %E Connex %E p-value SBP 0.4 0.0 0.316 54.5 0.0 ≤0.001 DBP 0.8 0.0 0.082 56.0 0.0 ≤0.001 MAP 2.5 0.0 0.014 7.2 0.0 ≤0.001 Pulse 0.8 0.4 0.563 68.0 0.0 ≤0.001 Temp 0.8 0.0 0.156 41.5 0.1 ≤0.001 SpO2 0.4 0.4 1.000 31.4 0.0 ≤0.001 Total% 1.0 0.1 0.003 43.3 0.1 ≤0.001
7. EWS Risk Band EWS Action Plan Acceptable EWS Time Period Normal 4 hrs 4 hrs +/- 30 mins of 4 hrs Normal 2 hrs 2 hrs +/- 15 mins of 2 hrs Observe 1 hrly +/- 10 mins of 1 hr Warning 30 mins +/- 5 mins of 30 mins Urgent 15 mins +/- 3 mins of 15 mins Protocol for EWS Risk Band
8. EWS Risk Band Analysis Adherence (%) to vital sign follow-up as determined by EWS Risk Band Assessment 29% 25% 6% 4% 36% Normal 4hr Normal 2hr Observe Warning Urgent Only 60 (24.7%) cycles had the correct follow up procedure followed
9. • Findings show significant error rates in documentation of vital signs in comparison to electronic collection and poor compliance to EWS protocols • Could be due to not only transcription errors but also chart design which hinders precise recording • Non-compliance with EWS protocol could be due to – Inaccurate manual recording of time – Vital signs not being recorded on the chart when collected – Prescribed time frames are inappropriate and/or impractical for clinical scenarios Conclusion and Discussion