In our September 11, 2012 Patient Safety Tip of the Week “In Search of the Ideal Early Warning Score” we discussed a recommendation in the UK for hospitals to adopt a national early warning score system. In February 2013 Ireland became the first country to adopt such a nationwide system (Press Release 2013).
The guideline applies to all adult patients in acute care hospital settings, including outpatients and day treatment patients receiving invasive procedures or moderate sedation. It does not apply to pediatric or obstetrical patients, for whom different physiological parameters apply. There are 60 recommendations in the guidelines. Both a summary of the guideline and a full text version are available.
But a new study points out one of the flaws in most early warning systems: incomplete recording of key elements in the early warning score (Hands 2013). Vital signs are key elements in all such scores but very often they are recorded inconsistently. The authors found only partial adherence to the vital signs monitoring protocol. Sicker patients were more likely to have vital signs measured overnight, but even their observations were often not followed by timely repeat assessments. The authors felt that the observed pattern of monitoring may reflect the impact of competing clinical priorities.
The whole point of early warning scores is to pick up on more subtle signs of clinical deterioration so that early interventions can take place. It is important that the data elements chosen for such scores will, in fact, be regularly assessed and used in the early warning score.
Press Release. Minister for Health, Dr. James Reilly TD endorses and launches first National Clinical Guideline: National Early Warning Score. 18th February 2013
Patient Safety Initiative in Ireland. National Clinical Effectiveness Committee. National Early Warning Score. National Clinical Guideline No. 1. An Roinn Slainte Department of Health. February 2013
full text of the guideline
Hands C, Reid E, Meredith P, et al. Patterns in the recording of vital signs and early warning scores: compliance with a clinical escalation protocol. BMJ Qual Saf 2013; published online first 19 April 2013 doi:10.1136/bmjqs-2013-001954
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