Lessons learnt from Early Warning Scoring Systems Research in Cape Town, South AfricaName : Dr. Una Kyriacos
Affliation : Associate Professor
University : University of Cape Town
Country : South Africa
In two studies we aimed to test the effectiveness of a Cape Town (CT) modified early warning score (MEWS) vital signs observation chart and SituationBackground-Assessment-Recommendation (SBAR) communication guide, following an educational intervention in adult medical and surgical wards. Outcomes: proportion of appropriate responses to deterioration, differences in recording of physiological parameters and serious adverse events (SAEs).
Materials & Methods:
Public teaching hospitals in the Western Cape, South Africa were randomized to implementation of the CT MEWS and SBAR guide or usual care. In the intervention arm, day and night shift nurses received training. Clinical records were reviewed retrospectively. Data were analysed using IBM SPSS (version 22).
Introduction of the MEWS was not associated with statistically significant changes in responses to clinical deterioration in 50 of 57 vs 55/57 patients (OR 0.26, 95% CI 0.05 to 1.31), despite improvement in nurses’ knowledge in intervention wards. 2015: No assistance was summoned for a single red MEWS for critical illness for 96% (43/45) of affected patients in the intervention arm (n=150) and 86% (70/81) of patients in the control arm (n=150). Nurses tended to disregard respiration rate. In both studies more patients in intervention than control wards had recordings of respiratory rate, of all seven parameters and in 2015 there was a significant difference in recording between trial arms for clinical parameters listed on the MEWS chart but omitted from the traditional ward observations chart. Three of 6 hospitals declined to participate.
Further work is needed on educational preparation for use of the CT MEWS and SBAR. Hospital management should invest in patient safety research.
Dr. Una Kyriacos is currently working as Associate Professor in the Division of Nursing & Midwifery, Faculty of Health Sciences, University of Cape Town, South Africa. She has completed her Ph. D in the year 2011 and did her Master of Science (Nursing) in the year 1993; She has a Postgraduate Diploma (2006) in Ophthalmic Nursing. She has done Assessor’s course in 2005. In Oral Roberts University, USA she has completed Nursing Graduate Studies (1 Semester) in 1990. She does Supervision of PhD and MSc candidates in university studies as an academecian. She participates in External examination appointments at 5 South African universities and Kenya. She is a reviewer for 7 nursing/medical Journals and acquired many international research grants.