References

Alexander G, Staggers N. A systematic review of the designs of clinical technology: findings and recommendations for future research. ANS Adv Nurs Sci. 2009; 32:(3)252-279 https://doi.org/10.1097/ANS.0b013e3181b0d737

Bellomo R, Ackerman M, Bailey M A controlled trial of electronic automated advisory vital signs monitoring in general hospital wards. Crit Care Med. 2012; 40:(8)2349-2361 https://doi.org/10.1097/ccm.0b013e318255d9a0

Black AD, Car J, Pagliari C The impact of eHealth on the quality and safety of health care: a systematic overview. PLoS Med. 2011; 8:(1) https://doi.org/10.1371/journal.pmed.1000387

Boonstra A, Broekhuis M. Barriers to the acceptance of electronic medical records by physicians from systematic review to taxonomy and interventions. BMC Health Serv Res. 2010; 10:(1) https://doi.org/10.1186/1472-6963-10-231

Buist M, Bernard S, Nguyen TV, Moore G, Anderson J. Association between clinically abnormal observations and subsequent in-hospital mortality: a prospective study. Resuscitation. 2004; 62:(2)137-141 https://doi.org/10.1016/j.resuscitation.2004.03.005

Burns KA, Reber T, Theodore K, Welch B, Roy D, Siedlecki SL. Enhanced early warning system impact on nursing practice: A phenomenological study. J Adv Nurs. 2018; 74:(5)1150-1156 https://doi.org/10.1111/jan.13517

Cooper S, Kinsman L, Buykx P, McConnell-Henry T, Endacott R, Scholes J. Managing the deteriorating patient in a simulated environment: nursing students' knowledge, skill and situation awareness. J Clin Nurs. 2010; 19:(15-16)2309-2318 https://doi.org/10.1111/j.1365-2702.2009.03164.x

Cresswell K, Sheikh A. Organizational issues in the implementation and adoption of health information technology innovations: an interpretative review. Int J Med Inform. 2013; 82:(5)e73-e86 https://doi.org/10.1016/j.ijmedinf.2012.10.007

Cretikos MA, Bellomo R, Hillman K, Chen J, Finfer S, Flabouris A. Respiratory rate: the neglected vital sign. Med J Aust. 2008; 188:(11)657-659 https://doi.org/10.5694/j.1326-5377.2008.tb01825.x

Cutcliffe JR, McKenna HP. When do we know that we know? Considering the truth of research findings and the craft of qualitative research. Int J Nurs Stud. 2002; 39:(6)611-618 https://doi.org/10.1016/S0020-7489(01)00063-3

Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci. 2009; 4:(1) https://doi.org/10.1186/1748-5908-4-50

Department of Health (Ireland). Irish National Early Warning System (INEWS) Version 2. National Clinical Guideline 1. September 2020 (updated version of guideline first published 2013). https://tinyurl.com/4s8jxjx2 (accessed 1 September 2021)

Foley C, Dowling M. How do nurses use the early warning score in their practice? A case study from an acute medical unit. J Clin Nurs. 2019; 28:(7-8)1183-1192 https://doi.org/10.1111/jocn.14713

Gagnon MP, Desmartis M, Labrecque M Systematic review of factors influencing the adoption of information and communication technologies by healthcare professionals. J Med Syst. 2010; 36:(1)241-277 https://doi.org/10.1007/s10916-010-9473-4

Healthcare Improvement Scotland. Making care better—better quality health and social care for everyone in Scotland. A strategy for supporting better care in Scotland 2017-2022. 2017. https://tinyurl.com/5u2258pz (accessed 17 August 2021)

Hogan H, Healey F, Neale G, Thomson R, Vincent C, Black N. Preventable deaths due to problems in care in English acute hospitals: a retrospective case record review study. BMJ Qual Saf. 2012; 21:(9)737-745 https://doi.org/10.1136/bmjqs-2011-001159

Hravnak M, Edwards L, Clontz A, Valenta C, Devita MA, Pinsky MR. Defining the incidence of cardiorespiratory instability in patients in step-down units using an electronic integrated monitoring system. Arch Intern Med. 2008; 168:(12)1300-1308 https://doi.org/10.1001/archinte.168.12.1300

Jäderling G, Bell M, Martling CR, Ekbom A, Bottai M, Konrad D. ICU admittance by a rapid response team versus conventional admittance, characteristics, and outcome. Crit Care Med. 2013; 41:(3)725-731 https://doi.org/10.1097/CCM.0b013e3182711b94

Jensen JK, Skår R, Tveit B. The impact of early warning score and rapid response systems on nurses' competence: an integrative literature review and synthesis. J Clin Nurs. 2018; 27:(7-8)e1256-e1274 https://doi.org/10.1111/jocn.14239

Ludikhuize J, Smorenburg SM, de Rooij SE, de Jonge E. Identification of deteriorating patients on general wards; measurement of vital parameters and potential effectiveness of the Modified Early Warning Score. J Crit Care. 2012; 27:(4)424.e7-424.e13 https://doi.org/10.1016/j.jcrc.2012.01.003

McGaughey J, Blackwood B, O'Halloran P, Trinder TJ, Porter S. Realistic evaluation of early warning systems and the acute life-threatening events—recognition and treatment training course for early recognition and management of deteriorating ward-based patients: research protocol. J Adv Nurs. 2010; 66:(4)923-932 https://doi.org/10.1111/j.1365-2648.2009.05257.x

McQuillan P, Pilkington S, Allan A Confidential inquiry into quality of care before admission to intensive care. BMJ. 1998; 316:(7148)1853-1858 https://doi.org/10.1136/bmj.316.7148.1853

National Confidential Enquiry into Patient Outcome and Death. An acute problem?. 2005. https://www.ncepod.org.uk/2005aap.html (accessed 17 August 2021)

Petersen JA, Antonsen K, Rasmussen LS. Frequency of early warning score assessment and clinical deterioration in hospitalized patients: a randomized trial. Resuscitation. 2016; 101:91-96 https://doi.org/10.1016/j.resuscitation.2016.02.003

Rattray JE, Lauder W, Ludwick R Indicators of acute deterioration in adult patients nursed in acute wards: a factorial survey. J Clin Nurs. 2011; 20:(5-6)723-732 https://doi.org/10.1111/j.1365-2702.2010.03567.x

Tobin GA, Begley CM. Methodological rigour within a qualitative framework. J Adv Nurs. 2004; 48:(4)388-396 https://doi.org/10.1111/j.1365-2648.2004.03207.x

Implementing technology to support the deteriorating patient in acute care: evaluating staff views

09 September 2021
12 min read
Volume 30 · Issue 16

Abstract

Background:

Early warning scores (EWS) have been widely used to aid in the detection of deterioration. The use of technology, alongside EWS, may improve patient safety and lead to improvements in the accuracy of documentation.

Aim:

The aim of this service evaluation was to understand nurses' and healthcare support worker views around the implementation of handheld electronic devices for documenting care related to the deteriorating patient.

Methods:

Before the implementation of an electronic handheld device, in-depth semi-structured interviews with nursing staff and healthcare support workers were undertaken to explore the context for improvement. The Consolidated Framework for Implementation Research was used to analyse, organise and present data, to ensure systematic inquiry across the range of potential facilitators and challenges perceived by staff. In all, 11 interviews were undertaken across three speciality areas (four wards).

Findings:

Challenges to the use of new technology included staff apprehension around training and education needs and the uncertainty of technological reliability in the clinical setting. Potential facilitators to support the implementation of this technology were: the potential for improved communication across the individual ward and hospital setting and the potential for more streamlined processes for escalation of concerns.

Conclusion:

Three main recommendations for practice emerged. First, nurses should be involved in the development of the systems. Appropriate time is required to embed the technology in practice. Finally, thought must be given not just to the absolute number of devices required and their reliability, but also how new technology interacts in each individual context.

Improving the safety of patient care is a priority for service users, frontline staff, healthcare managers and policymakers (Healthcare Improvement Scotland, 2017). This is especially true in the acute care hospital setting, which is known to be an area where there is a high incidence of preventable harms (Hogan et al, 2012). A specific target area for the prevention of patient harm is the management of the deteriorating patient (Jensen et al, 2018).

In the hours leading up to a cardiac arrest or an admission to an intensive care unit (ICU), many patients on general hospital wards have signs and symptoms of clinical deterioration (McGaughey et al, 2010). Evidence demonstrates that up to 80% of patients could be identified in the 24 hours before one of the above events and that 21-41% of ICU admissions from general ward settings are potentially avoidable (McQuillan et al, 1998; National Confidential Enquiry into Patient Outcome and Death, 2005; Buist et al, 2004). Furthermore, patients transferred unexpectedly to the ICU often have worse clinical outcomes and increased mortality (Jäderling et al, 2013).

Register now to continue reading

Thank you for visiting British Journal of Nursing and reading some of our peer-reviewed resources for nurses. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to clinical or professional articles

  • Unlimited access to the latest news, blogs and video content