Ensuring warning systems work

A Queensland nurse has been researching the effectiveness of “track and trigger” systems to alert nurses to patient deterioration.

Modified Early Warning Scoring (MEWS/EWS) systems help nurses monitor the condition of patients in their care and get them seen if their condition deteriorates, but they don’t always work as intended.

Central Queensland University master’s degree student Andrea Reid has examined nurses’ use of these “track and trigger” systems within acute care hospitals. Reid has been nursing for 22 years and currently works as a nurse educator at Rockhampton Hospital.

For her research, she individually interviewed 14 registered nurses from across Australia and found they had a good understanding of these systems and certainly use them. They are particularly appreciated by novice nurses as a tool to communicate severity of illness and get the patient seen by a doctor.

However, Reid identified a series of points where the escalation process can fail, with influencing factors being education, training, experience, working conditions and environment, along with decision-making and communication issues.

She said a shared understanding was essential when using a MEWS/EWS system. “When the multidisciplinary team had a shared understanding, the process was more effective in getting the patient seen,” Reid found; “however, when a shared understanding was absent, the nurses circumnavigated the [escalation] process by calling the medical emergency team to ultimately keep the patient safe.”

Reid said that nurses have everyday contact with patients and have responsibility for monitoring and interpreting the patients’ vital signs, and “this contact puts them in the principal position to detect patients’ physiological changes and act accordingly”.

With many different track-and-trigger systems in use across Australia and internationally, Reid is strongly recommending their standardisation to address the disparities between Australian hospitals, improve patient safety and make it easier to train health professionals.

She said a shared approach by healthcare executives and clinical governance teams was necessary when implementing early warning systems to ensure that processes for recognising and responding to clinical deterioration are met. She also said healthcare facilities needed to improve communication, leadership and other teamwork skills and deliver education programs and training that is multidisciplinary.

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