Yiu C J, Khan S U, Subbe C P, Tofeec K, Madge R A
Consultant in Acute Medicine, Respiratory & Critical Care Medicine, Ysbyty Gwynedd, United Kingdom and Senior Clinical Lecturer, School of Medical Sciences, Bangor University, Bangor, UK.
Acute Med. 2014;13(2):56-60.
Early Warning Scores alert staff to preventable deterioration. Raised scores should lead to escalation of care.
To establish response of staff to patients scoring National Early Warning Score (NEWS) of six or above and to identify patient and environmental factors affecting escalation by nursing staff.
Service evaluation with prospective review of patient records of 118 beds on four medical wards during 20 night-shifts.
During 2360 observed bed days 109 patients triggered NEWS>=6 at least once during the observation period. Nursing staff escalated only 18 (17%) of these patients; nearly all of them had predefined chronic health conditions, the majority fulfilled criteria for frailty. Despite their higher 30-day mortality patients with COPD had lower escalation rates. Additionally wards that had more patients with a NEWS>=6 had lower escalation rates.
Alarm fatigue and clinical judgement of staff might result in deviation from escalation protocols.
早期预警评分可提醒工作人员预防病情恶化。评分升高应促使护理级别升级。
确定工作人员对国家早期预警评分（NEWS）为6分及以上患者的反应，并识别影响护理人员升级护理的患者及环境因素。
通过前瞻性回顾四个内科病房118张床位在20个夜班期间的患者记录进行服务评估。
在2360个观察床日期间，109名患者在观察期内至少有一次触发NEWS≥6。护理人员仅对其中18名（17%）患者升级护理；几乎所有这些患者都有预先确定的慢性健康状况，大多数符合虚弱标准。尽管慢性阻塞性肺疾病（COPD）患者30天死亡率较高，但升级护理率较低。此外，NEWS≥6的患者较多的病房升级护理率较低。
警报疲劳和工作人员的临床判断可能导致偏离升级护理方案。
