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Background. staff "... rarely carry out routine observations during the night "... observations are seen as tasks with a low priority ..." National Patient Safety Agency (2007) Recognising and responding appropriately to early signs of deterioration in hospitalised patients. NPSA, London.

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background
Background
  • staff "...rarely carry out routine observations during the night

"...observations are seen as tasks with a low priority..."

National Patient Safety Agency (2007) Recognising and responding appropriately to early signs of deterioration in hospitalised patients. NPSA, London.

  • physiological observations should be monitored at least every 12 hours with the frequency increasing if abnormal physiology was detected.

National Institute for Health and Clinical Excellence. NICE clinical guideline 50 Acutely ill patients in hospital: recognition of and response to acute illness in adults in hospital. London, National Institute for Health and Clinical Excellence, 2007.

slide2

Path labs DBS

  • Heart rate
  • Blood pressure
  • Respiratory rate
  • Oxygen saturation
  • Temperature
  • Conscious level
  • Inspired oxygen
  • Other data

Server

PAS

DBS

slide3

ViEWS (VitalPAC™ Early Warning Score)

YES

111 – 249

>250

< 40

Prytherch et al. Resuscitation 2010; 81: 932–937

slide4

National Early Warning Score (NEWS)

Royal College of Physicians of London, 2012

slide6

NEWS adopted by 1/3 rd English hospitals

  • Further 1/3rd state intention to adopt
  • NEWS nationwide Wales
  • ViEWS nationwide Ireland
  • Currently being trialled in Denmark and Holland.
  • ViEWS externally validated US, Canada, Uganda
slide7

Papers 2010-13

  • Carr E, Meredith P, Chumbley G, Killen R, Prytherch DR, Smith GB. Pain during admission to a United Kingdom District General Hospital. Should pain be a patient safety issue? Journal of Advanced Nursing 2013 in press.

Hands C, Reid E, Meredith P, Smith GB, Prytherch DR, Schmidt PE, Featherstone PI.

Patterns in the recording of vital signs and early warning scores - time of day, day of week.

BMJ Quality & Safety 2013 in press.

Mohammed MA, Rudge G, Watson D, Wood G, Smith GB, Prytherch D, Dirling A, Stevens A.

Index blood tests and national early warning scores within 24 hours of emergency admission can predict the risk of in-hospital mortality: a model development and validation study.PLoS ONE 2013 in press

Smith GB, Prytherch DR, Meredith P, Schmidt PE, Featherstone PI. The ability of the National Early Warning Score (NEWS) to discriminate patients at risk of early cardiac arrest, unanticipated intensive care unit admission, and death Resuscitation 2013;84:465-470.

Mohammed MA, Rudge G, Wood G, Smith GB, Nangalia V, Prytherch D, Holder R, Briggs J. Which is more useful in predicting hospital mortality - dichotomised blood test results or actual test values? A retrospective study in two hospitals. PLoS ONE 2012 7(10): e46860. doi:10.1371/journal.pone.0046860

Smith GB, Prytherch DR, Watson D, Forde V, Windsor A, Schmidt PE, Featherstone PI, Higgins B, Meredith P. SpO2 values in acute medical admissions breathing air – implications for the British Thoracic Society guideline for emergency oxygen use in adult patients? Resuscitation 2012; 83: 1201-1205

Nangalia V, Prythrech DR, Smith GB. Health technology assessment review: Remote monitoring of vital signs – current status and future challenges. Critical Care 2010; 14: 233

Prytherch D, Smith GB, Schmidt PE, Featherstone PI. ViEWS - towards a national Early Warning Score for detecting adult inpatient deterioration. Resuscitation 2010; 81: 932–937.

slide8

Items Submitted for publication

  • Badriyah T, Briggs JS, Meredith P, Schmidt PE, Featherstone PI, Prytherch DR, Smith GB. Decision-tree early warning score (DTEWS) validates the design characteristics of the National Early Warning Score (NEWS). Submitted to Resuscitation.
  • Jarvis SJ, Kovacs C, Badriyah T, Briggs JS, Mohammed MA, Meredith P, Schmidt PE, Featherstone PI, Prytherch DR, Smith GB. Development and validation of a decision-tree early warning score based on routine laboratory result tests for the discrimination of hospital mortality. Submitted to Resuscitation.