Title: | Capturing early signs of deterioration: the dutch-early-nurse-worry-indicator-score and its value in the Rapid Response System |
Author(s): | Douw, G. ; Huisman-de Waal, G.J. ; Zanten, A.R. van; Hoeven, J.G. van der ; Schoonhoven, L. |
Publication year: | 2017 |
Source: | Journal of Clinical Nursing, vol. 26, iss. 17-18, (2017), pp. 2605-2613 |
ISSN: | 0962-1067 |
DOI: | https://doi.org/10.1111/jocn.13648 |
Publication type: | Article / Letter to editor |
Please use this identifier to cite or link to this item : https://hdl.handle.net/2066/177311 ![]() |
|
Subject: | Radboudumc 18: Healthcare improvement science RIHS: Radboud Institute for Health Sciences Radboudumc 4: lnfectious Diseases and Global Health RIHS: Radboud Institute for Health Sciences Tijdelijke code tbv inlezen publicaties Radboudumc - Alleen voor gebruik door Radboudumc |
Organization: | IQ Healthcare Intensive Care |
Journal title: |
Journal of Clinical Nursing
|
Volume: | vol. 26 |
Issue: | iss. 17-18 |
Page start: | p. 2605 |
Page end: | p. 2613 |
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.
|