Understanding the use of the National Early Warning Score 2 in acute care settings: a realist review protocol.

Introduction: Failure to recognise and respond to patient deterioration in an appropriate and timely manner has been highlighted as a global patient safety concern. Early Warning Scores (EWSs) using vital signs were introduced to address this concern, with the aim of getting the patient timely and appropriate treatment. The National Early Warning Score 2 (NEWS2) is in use across the NHS, and many other settings globally.

A practical approach to establishing a critical care outreach service: An expert panel research design.

Background: For over two decades, nurse-led critical care outreach services have improved the recognition, response, and management of deteriorating patients in general hospital wards, yet variation in terms, design, implementation, and evaluation of such services continue. For those establishing a critical care outreach service, these factors make the literature difficult to interpret and translate to the real-world setting.

Aim: The aim of this study was to provide a practical approach to establishing a critical care outreach service in the hospital setting.

When patients (and families) raise the alarm: Patient and family activated rapid response as a safety strategy for hospitals.

Patients and those close to them often have an intimate understanding of their condition and can participate in a broad range of clinical processes. During times of deterioration, their concerns might go unheard. Advocacy of family and friends can fulfil an important safety function and can support patients and healthcare professionals looking after them.

Patient- and relative-activated critical care outreach: a 7-year service review.

Five years following the introduction of a whole-hospital, 24-hour critical care outreach (CCO) service, an additional service was introduced that enabled patients and their families to directly call the CCO team if they had concerns that were not being acknowledged by the patient's clinical team. The aim of this review was to report on 7 years of patient and family referrals using quantitative and free text data extracted from the CCO referral database. Information on demographics, frequency, nature and reason for the referrals have been reported that highlight the feasibility of such a service, and the potential to prevent patient deterioration.

Detection and management of the deteriorating ward patient: an evaluation of nursing practice.

Aims And Objectives: To audit ward nursing practice in the adherence to an early warning scoring protocol in the detection and initial management of the deteriorating ward patient and investigate factors that may impact on practice.

Background: Hospital inpatients can experience unexpected physiological deterioration leading to poor outcomes and death. Although deterioration can be signalled in the patients' physiological symptoms, evidence suggests that ward staff can miss, misinterpret or mismanage the signs.

An audit of independent nurse prescribing in a critical care outreach team.

Background: In 2006, legislative changes enabled independent prescribers to prescribe any licensed medication within their field of expertise. This has transformed nurse prescribing and opened up more opportunities for nurses to develop their practice in acute care settings. The need for further evaluation in this developing area of advanced practice was highlighted in the British Association of Critical Care Nurses (BACCN) position statement published in 2009.

Human factors and patient safety: changing roles in critical care.

The high numbers of patients suffering from adverse incidents has resulted in wide spread commitment to improving patient safety. While a lack of technical skill can play a part, there is growing evidence that poor non-technical skills can be a major cause of error in healthcare. Non-technical skills, or human factors, play an important role in improving team function and improving these skills can drive improvements in patient safety and outcome.

Call 4 Concern: patient and relative activated critical care outreach.

Patients can experience unexpected deterioration in their physiological condition that can lead to critical illness, cardiac arrest, admission to the intensive care unit and death. While ward staff can identify deterioration through monitoring physiological signs, these signs can be missed, interpreted incorrectly or mismanaged. Rapid response systems using early warning scores can fail if staff do not follow protocols or do not notice or manage deterioration adequately.

Nurses' role in detecting deterioration in ward patients: systematic literature review.

Aim: This paper is a report of a review conducted to identify and critically evaluate research investigating nursing practice in detecting and managing deteriorating general ward patients.

Background: Failure to recognize or act on deterioration of general ward patients has resulted in the implementation of early warning scoring systems and critical care outreach teams. The evidence of effectiveness of these systems is unclear.

Are early warning scores the only way to rapidly detect and manage deterioration?

A systematic literature review recently highlighted the complexity of nursing practice in terms of detecting and managing deteriorating ward patients (Odell et al, 2009). The findings suggest that rapid response systems, including early warning scores, may not be the only solution to the problems of detecting and managing signs of deterioration. This article summarises the findings of this review.

Understanding 'do not attempt resuscitation' orders.

This article outlines the issues that influence the process of writing a 'do not attempt resuscitation' order. It discusses advance directives, the Mental Capacity Bill and patient and relative involvement, and their impact on making decisions about cardiopulmonary resuscitation (CPR).

A review of nursing skill-mix to optimise care in an acute trust.

The main resource of the NHS is its workforce. However, achieving the correct mix of staff is crucial if it is to provide high-quality patient care in a cost-effective manner. When an acute trust was singled out in an independent analysis as having 'too rich' a skill-mix (compared with the rest of the strategic health authority), an internal review was undertaken to determine the ratio of qualified to unqualified nursing staff, and to compare these with acuity and dependency in each clinical area.

Sepsis: early detection and care.

Nurses need to be aware of the signs and symptoms of sepsis. Staff education to encourage the early identification of this life-threatening condition will be aided by a new resource kit.

The critical care outreach service and the early warning system on surgical wards.

The implementation and evaluation of a modified early warning system (MEWS) on surgical wards are described. The MEWS was found to be a useful adjunct to the outreach service. Early data have shown that MEWS can help direct critical intervention.