Background
Vital sign | 3 | 2 | 1 | 0 | 1 | 2 | 3 |
---|---|---|---|---|---|---|---|
Respiratory Rate pr min | <9 | 9–11 | 12–20 | 21–24 | >24 | ||
Oxygen saturation | <92% | 92–93% | 94–95% | >95% | |||
Supplemental oxygen | YES | No | |||||
Temperature degrees centigrade | <35.1 | 35.1–36.0 | 36.1–38.0 | 38.1–39.0 | >39 | ||
Systolic blood pressure mmHg | <91 | 91–100 | 101–110 | 111–219 | >219 | ||
Heart rate pr min | <41 | 41–50 | 51–90 | 91–110 | 111–130 | >130 | |
Level of consciousness | A | V, P, U |
EWS | Frequency of monitoring | Clinical response according to escalation protocol |
---|---|---|
0–1 | Minimum 12 hourly | • Continue monitoring minimum 12 hourly |
2 | Minimum 6 hourly | • Assessment of airway, breathing and circulation and appropriate intervention |
3–5 | Minimum 4 hourly | • Assessment of airway, breathing and circulation and appropriate intervention • Nurse in charge informs on-call physician, who assesses patient and plans appropriate treatment and/ or diagnostics |
6 | Minimum 4 hourly | • Assessments of airway, breathing and circulation and intervenes appropriately • Urgent assessment by on-call physician, including plan for appropriate treatment and diagnostics |
7–8 | Minimum 1 hourly | • Assessment of airway, breathing and circulation and appropriate intervention • Emergency assessment (within 30 min) by on-call physician, including plan for appropriate treatment and diagnostics • Consider call to medical emergency team (MET) |
≥ 9 | Minimum ½ hourly | • Assessment of airway, breathing and circulation and appropriate intervention • Emergency assessment (within 15 min) by on-call physician, including plan for appropriate treatment and diagnostics • Patient must be evaluated with senior physician or MET |
Methods
EWS system and MET
Study design
Setting
Participants
Themes | Interview questions |
---|---|
Briefing and introduction | • Introduction of the interviewers and aim of the interview • Briefing that participation in the interview is voluntary and data will be published anonymized • I ask the participants to briefly introduce themselves by name, place of employment, and how long they have been nurses and worked on the ward |
General aspects of knowledge and understandings of acutely deteriorating patients | • In your opinion, what is an acutely deteriorating patient? ○ Try to describe your last acutely deteriorating patient. ○ What connections do you see between critical illness and patients’ diagnosis? ○ What connections do you see between critical illness and patients’ vital signs? ○ What connections do you see between critical illness and progression in patients’ condition? ○ What connections do you see between critical illness and patients’ co-morbidities? ○ In your opinion, are there any other findings that lead you to conclude that a patient is acutely deteriorating? |
General aspects of handling acutely deteriorating patients on the wards | • Try to tell how you typically handle acutely deteriorating patients on your ward ○ What is the role of other nurses? ○ How do you delegate tasks between doctors and nurses on your wards? ○ How do you typically identify at risk patients on your wards? ○ How do you determine how close patients should be monitored on your wards? ○ How do you decide what interventions and treatments acutely deteriorating patients receive on your wards? ○ How do you determine if you need further assistance to handle acutely deteriorating patients on your wards? |
General aspects of the role of early warning score in identifying and handling acutely deteriorating patients | • In your opinion, what is the role of EWS and the related algorithm in handling acutely deteriorating patients? ○ Try to describe if and when you use EWS in identifying acutely deteriorating patients. ○ Try to describe if and when you use EWS in monitoring acutely deteriorating patients. ○ Try to describe if and when you use EWS in stabilizing acutely deteriorating patients. ○ Try to describe if and when you use EWS to obtain necessary assistance in handling acutely deteriorating patients. |
Specifically about barriers and facilitators in relation to adherence to monitoring frequency | • Try to describe what issues make it easy or hard to adhere to the prescribed monitoring frequency of the EWS algorithm. ○ In what circumstances would you typically deviate from the algorithm and monitor more or less frequently? ○ What issues in your daily work life impact on the adherence to the algorithm? • Do you consider it important to adhere to the prescribed monitoring frequency? • What could be done to make it easier to adhere to the prescribed monitoring frequency? |
Specifically about barriers and facilitators in relation to inform junior doctors about patients with moderately elevated EWS (≥ 3) | • According to the algorithm junior doctors must be informed about every patient with a moderately elevated EWS of 2–3, what do you think of that? ○ How often do you inform junior doctors about these patients? ○ Under what circumstances do you inform junior doctors about these patients? ○ When do you decide not to inform them? ○ What issues in your daily work life impact on the adherence to the algorithm? • In your opinion, what is the most important issue that determines whether you do or do not inform junior doctors? • What could be done to make it easier to inform junior doctors? |
Specifically about barriers and facilitators in relation to MET calls | • Try to describe when you last made a MET call? • In what circumstances do you use MET? ○ Are there specific categories of patients where you call MET? ○ Are there specific times of the day when you use MET? ○ What criteria do you use to determine whether to call for MET or not? ○ What issues in your daily work life impact on the adherence to the algorithm in regard to MET calls? • When do you not use MET? • What is the role of EWS in your decision to call MET? • In your opinion, what is the most important issue that determines whether you do or do not inform junior doctors? • What could be done to make it easier to use MET? |
Debriefing | • Are there any important issues we need to talk about in regard to acutely deteriorating patients? • Thank you for your participation. |