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dc.contributor.authorGarrett, Stacy L.
dc.date.accessioned2021-05-24T19:21:57Z
dc.date.available2021-05-24T19:21:57Z
dc.date.issued2021-05
dc.identifier.urihttp://hdl.handle.net/10713/15754
dc.description.abstractProblem & Purpose: Unrecognized clinical deterioration leads to poor outcomes including unanticipated intensive care unit (ICU) admission, cardiac arrest and death. Statistics show 59.4% of patients have one abnormal vital sign one to four hours prior to cardiac arrest. The National Early Warning Score (NEWS) assists nurses to identify early clinical decompensation and intervene to prevent poor outcomes. Previous attempts to implement NEWS and a dedicated rapid response nurse (RRN) at a community sized military treatment facility were unsuccessful for improving early recognition of clinical deterioration. Prior to implementation less than 8.3% of patients at moderate risk for clinical decompensation were assessed by the RRN. The purpose of this quality improvement project was to improve early recognition of clinical deterioration by implementing a dual approach that targets both the RRN and ward nurses. Both approaches target patients at moderate to high risk of clinical decompensation to achieve early stabilization or transfer to a higher level of care. Methods: A standardized communication tool was created and utilized by the RRNs to track and trend patients with a NEWS of three to five and as a reminder to document their assessment in the electronic health record (EHR). Re-education and a workflow diagram for ward nurses was presented during a skills fair to increase assessment and vital sign frequency according to the existing NEWS protocol. Results: Over 13 weeks, 698 NEWS triggers were analyzed. Of these NEWS greater than or equal to five triggers, 76% (n= 57) were assessed by the RRN using the communication tool. Of the 76%, 84% (n=48), were physically assessed. Increased vital sign and assessment frequency by the ward nurses was highly variable throughout the implementation phase, 6.7-80% and 0- 27.2%, respectively. Conclusions: A standardized communication tool utilized by the RRNs increased RRN adherence to the NEWS protocol, achieving early identification and assessment of patients with a NEWS of three to five. NEWS greater than or equal to five identified patients at greater risk for deterioration and were associated with increased ward nurse adherence to the NEWS protocol. Improved early identification of deterioration may decrease unanticipated intensive care unit (ICU) admissions.en_US
dc.language.isoen_USen_US
dc.subjectNational Early Warning Score (NEWS)en_US
dc.subject.meshClinical Deteriorationen_US
dc.subject.meshInpatientsen_US
dc.subject.meshQuality Improvementen_US
dc.titleImplementation of the National Early Warning Score in a Military Hospitalen_US
dc.title.alternativeEvaluation of Implementation of NEWSen_US
dc.typeDNP Projecten_US
dc.contributor.advisorSeidl, Kristin L.
refterms.dateFOA2021-05-24T19:21:58Z


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