Smith Duncan J, Aitken Leanne M
School of Health Sciences, City University London, London, UK.
Patient Emergency Response and Resuscitation Team (PERRT), University College London Hospitals, London, UK.
J Clin Nurs. 2016 Jan;25(1-2):175-85. doi: 10.1111/jocn.13104.
To investigate nurses' use of a single parameter track and trigger chart to inform implementation of the National Early Warning Scoring tool. To report the characteristics of patients with triggers, the frequency of different triggers, and the time taken to repeat observations. To explore the barriers and facilitators perceived by nursing staff relating to patient monitoring.
Sub-optimal care of the deteriorating patient has been described for almost two decades. Organisations have responded by implementing strategies that improve monitoring and facilitate a timely response to patient deterioration. While these systems have been widely adopted the evidence-base to support their use is inconsistent.
A mixed method service evaluation was carried out in an acute University hospital.
Physiological triggers (n = 263) and characteristics of triggering patients (n = 74) were recorded from surgical and medical wards. Descriptive statistics were displayed. Questionnaires were distributed (n = 105) to student nurses, health care assistants and registered nurses. Themes and sub-themes were identified from content analysis.
Hypotension was the most frequent abnormality. There was variability in the time to repeat observations following a trigger. A high proportion of triggers were identified in older patients, as was a trend of longer time intervals between trigger and repeat observations. Nurses reported a number of barriers and facilitators to monitoring patients including: 'workload', 'equipment', 'interactions between staff' and 'interactions with patients'.
This study identified a number of barriers and facilitators to monitoring and escalation of abnormal vital signs, highlighting the complexity of the process and the need for a system-wide approach to a deteriorating patient.
The trend of longer delays following a trigger in older patients has not been identified previously and could reflect a knowledge gap of the physiological changes and response to acute illness in older people.
调查护士使用单一参数追踪与触发图表以促进国家早期预警评分工具的实施情况。报告触发患者的特征、不同触发因素的频率以及重复观察所需的时间。探索护理人员在患者监测方面所感知到的障碍与促进因素。
近二十年来，对病情恶化患者的护理欠佳问题一直存在描述。各机构已通过实施改善监测并促进对患者病情恶化及时做出反应的策略来应对。虽然这些系统已被广泛采用，但支持其使用的证据基础并不一致。
在一所大学附属医院进行了一项混合方法的服务评估。
记录了外科和内科病房的生理触发因素（n = 263）及触发患者的特征（n = 74）。展示了描述性统计数据。向实习护士、医疗保健助理和注册护士发放了问卷（n = 105）。通过内容分析确定了主题和子主题。
低血压是最常见的异常情况。触发后重复观察的时间存在差异。在老年患者中发现高比例的触发因素，触发与重复观察之间的时间间隔也有延长的趋势。护士报告了在监测患者方面的一些障碍和促进因素，包括：“工作量”、“设备”、“工作人员之间的互动”以及“与患者的互动”。
本研究确定了在监测和升级异常生命体征方面的一些障碍和促进因素，凸显了该过程的复杂性以及对病情恶化患者采取全系统方法的必要性。
此前未发现老年患者触发后延迟时间更长的趋势，这可能反映了对老年人急性疾病生理变化和反应的知识差距。
