Department of Internal Medicine, Radboud university medical center, Nijmegen, the Netherlands; Department of Surgery, Radboud university medical center, Nijmegen, the Netherlands.
Department of Internal Medicine, Radboud university medical center, Nijmegen, the Netherlands; Radboud REshape Center for Innovation, Radboud university medical center, Nijmegen, the Netherlands.
Int J Nurs Stud. 2021 Mar;115:103849. doi: 10.1016/j.ijnurstu.2020.103849. Epub 2020 Dec 16.
Periodic vital sign monitoring is commonly used to detect clinical deterioration. Incomplete assessment of Early Warning Score (EWS) and poor protocol compliance may negatively impact nurses' responsiveness to critical situations.
This study assesses the quality of recorded EWSs and the degree of overall protocol compliance and protocol compliance in adverse event patients, in a centre that is an early adopter of an EWS safety protocol.
Retrospective single-centre cohort study.
General hospital wards of a tertiary referral university medical centre.
48,864 patients admitted to general wards between 2015 and 2018.
Vital sign and Modified EWS (MEWS) data were collected from the electronic health record. MEWS completeness was evaluated by determining the proportion of missing values for each vital sign. To evaluate protocol compliance, we assessed whether the elapsed time between consecutive MEWSs was within the protocollary time as dictated by the MEWS protocol. Outcome measures were overall MEWS completeness, and both overall protocol compliance and protocol compliance specifically in the 24 h before adverse events.
All required items to calculate a MEWS were present in 76 percent of the 1,663,743 vital sign measurements. Overall protocol compliance was 62 percent. For the low, mid-range and high MEWS groups, protocol compliances were 67, 47 and 30 percent, respectively. Time-to-next-MEWS exceeded protocol-recommended timing by up to 9 h for a substantial amount of MEWSs in the mid- and high-range MEWS groups. In patients with adverse events, compliance to the MEWS protocol during the 24 h prior to the events was 66 percent in aggregate, ranging from 80% in low MEWS groups, 74% in the mid-range, and 49% in the high MEWS groups. In the high MEWS group, improvements in protocol compliance were primarily noted in five hours immediately preceding the event.
EWS assessments were incomplete in one-quarter of measurements. Compliance to a MEWS safety protocol was generally low, specifically when the protocol mandated more frequent MEWS assessments. Although more MEWSs were recorded in patients with adverse events, the increase in vital sign measurements' frequency mostly occurred shortly before the event manifested. This finding suggests missed opportunities to detect clinical deterioration.
定期监测生命体征通常用于检测临床恶化情况。早期预警评分（EWS）评估不完整和协议遵守情况不佳可能会影响护士对危急情况的反应能力。
本研究评估了在一个早期采用 EWS 安全协议的中心，记录的 EWS 的质量以及整体协议遵守情况和不良事件患者的协议遵守情况。
回顾性单中心队列研究。
一家三级转诊大学医学中心的普通病房。
2015 年至 2018 年间入住普通病房的 48864 名患者。
从电子健康记录中收集生命体征和改良 EWS（MEWS）数据。通过确定每个生命体征的缺失值比例来评估 MEWS 的完整性。为了评估协议遵守情况，我们评估了连续 MEWS 之间的时间间隔是否在 MEWS 协议规定的时间范围内。主要结局指标是整体 MEWS 完整性，以及不良事件发生前 24 小时的整体协议遵守情况和协议遵守情况。
在 1663743 次生命体征测量中，有 76%的测量值都包含计算 MEWS 所需的所有项目。整体协议遵守率为 62%。对于低、中、高 MEWS 组，协议遵守率分别为 67%、47%和 30%。在中、高 MEWS 组中，相当一部分 MEWS 的下一次 MEWS 时间超过了协议推荐的时间，最长可达 9 小时。在发生不良事件的患者中，事件发生前 24 小时内 MEWS 协议的总体依从率为 66%，低 MEWS 组为 80%，中 MEWS 组为 74%，高 MEWS 组为 49%。在高 MEWS 组中，协议依从性的改善主要发生在事件发生前的五个小时内。
四分之一的测量值中 EWS 评估不完整。对 MEWS 安全协议的遵守情况总体上较低，尤其是当协议要求更频繁地进行 MEWS 评估时。尽管在发生不良事件的患者中记录了更多的 MEWS，但生命体征测量频率的增加主要发生在事件表现之前的短时间内。这一发现表明错过了检测临床恶化的机会。
