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J Clin Nurs. 2017 Sep;26(17-18):2605-2613. doi: 10.1111/jocn.13648. Epub 2017 Feb 19.

Capturing early signs of deterioration: the dutch-early-nurse-worry-indicator-score and its value in the Rapid Response System.

Author information

1
Care Division, Gelderse Vallei Hospital, Ede, The Netherlands.
2
Radboud University Medical Centre, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ Healthcare), Nijmegen, The Netherlands.
3
Nursing Science, Radboud University Medical Centre, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ Healthcare), Nijmegen, The Netherlands.
4
Radboud University Medical Centre, Nijmegen, The Netherlands.
5
Faculty of Health Sciences, Level A (MP11) South Academic Block, Southampton General Hospital, University of Southampton, Southampton, UK.
6
National Institute for Health Research Collaboration for Applied Health Research and Care (CLAHRC) Wessex, Southampton, UK.

Abstract

AIMS AND OBJECTIVES:

To determine the predictive value of individual and combined dutch-early-nurse-worry-indicator-score indicators at various Early Warning Score levels, differentiating between Early Warning Scores reaching the trigger threshold to call a rapid response team and Early Warning Score levels not reaching this point.

BACKGROUND:

Dutch-early-nurse-worry-indicator-score comprises nine indicators underlying nurses' 'worry' about a patient's condition. All indicators independently show significant association with unplanned intensive care/high dependency unit admission or unexpected mortality. Prediction of this outcome improved by adding the dutch-early-nurse-worry-indicator-score indicators to an Early Warning Score based on vital signs.

DESIGN:

An observational cohort study was conducted on three surgical wards in a tertiary university-affiliated teaching hospital.

METHODS:

Included were surgical, native-speaking, adult patients. Nurses scored presence of 'worry' and/or dutch-early-nurse-worry-indicator-score indicators every shift or when worried. Vital signs were measured according to the prevailing protocol. Unplanned intensive care/high dependency unit admission or unexpected mortality was the composite endpoint. Percentages of 'worry' and dutch-early-nurse-worry-indicator-score indicators were calculated at various Early Warning Score levels in control and event groups. Entering all dutch-early-nurse-worry-indicator-score indicators in a multiple logistic regression analysis, we calculated a weighted score and calculated sensitivity, specificity, positive predicted value and negative predicted value for each possible total score.

RESULTS:

In 3522 patients, 102 (2·9%) had an unplanned intensive care/high dependency unit admissions (n = 97) or unexpected mortality (n = 5). Patients with such events and only slightly changed vital signs had significantly higher percentages of 'worry' and dutch-early-nurse-worry-indicator-score indicators expressed than patients in the control group. Increasing number of dutch-early-nurse-worry-indicator-score indicators showed higher positive predictive values.

CONCLUSIONS:

Dutch-early-nurse-worry-indicator-score indicators alert in an early stage of deterioration, before reaching the trigger threshold to call a rapid response team and can improve interdisciplinary communication on surgical wards during regular rounds, and when calling for assistance.

RELEVANCE TO CLINICAL PRACTICE:

Dutch-early-nurse-worry-indicator-score structures communication and recording of signs known to be associated with a decline in a patient's condition and can empower nurses to call assistance on the 'worry' criterion in an early stage of deterioration.

KEYWORDS:

deterioration; dutch-early-nurse-worry-indicator-score; hospital rapid response team; intensive care unit; nurses; worry

PMID:
27865003
DOI:
10.1111/jocn.13648
[Indexed for MEDLINE]

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