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J Nurs Care Qual. 2014 Jul-Sep;29(3):215-22. doi: 10.1097/NCQ.0000000000000058.

Inpatient nursing care and early warning scores: a workflow mismatch.

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  • 1Department of Critical Care Medicine (Drs Watson and Levin), Neuroscience and Surgical Nursing (Ms Skipper), Children's National Heart Institute (Ms Steury), and Board of Visitors Simulation Program (Ms Walsh), Children's National Medical Center, Washington, District of Columbia.


Early warning scores calculated by registered nurses (RNs) are used in hospitals to enhance the recognition of and communication about patient deterioration. This study evaluated workflow variables surrounding calculation and documentation of one pediatric hospital's use of an early warning score. Results indicated that there were significant delays in documentation of early warning scores by RNs and inconsistencies between the early warning scores and vital signs collected and documented by non-RN personnel. These findings reflected information obtained from the RNs about how they prioritize tasks and use work-arounds to specific systems issues regarding assessment and documentation in the electronic medical record.

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