Limits...
Early warning scoring systems versus standard observations charts for wards in South Africa: a cluster randomized controlled trial.

Kyriacos U, Jelsma J, James M, Jordan S - Trials (2015)

Bottom Line: Control wards delivered standard care, without training.More patients in intervention than control wards had recordings of respiratory rate (27 of 57 versus 2 of 57, OR: 24.75, 95% CI: 5.5 to 111.3) and recordings of all seven parameters (5 of 57 versus 0 of 57 patients, risk estimate: 1.10, 95% CI: 1.01 to 1.2).A MEWS chart and training program enhanced recording of respiratory rate and of all parameters, and nurses' knowledge, but not nurses' responses to patients who triggered the MEWS reporting algorithm.

View Article: PubMed Central - PubMed

Affiliation: Division of Nursing and Midwifery, Department of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Anzio Road, Cape Town, 7925, South Africa. una.kyriacos@uct.ac.za.

ABSTRACT

Background: On South African public hospital wards, observation charts do not incorporate early warning scoring (EWS) systems to inform nurses when to summon assistance. The aim of this trial was to test the impact of a new chart incorporating a modified EWS (MEWS) system and a linked training program on nurses' responses to clinical deterioration (primary outcome). Secondary outcomes were: numbers of patients with vital signs recordings in the first eight postoperative hours; number of times each vital sign was recorded; and nurses' knowledge.

Methods/design: A pragmatic, parallel-group, cluster randomized, controlled clinical trial of intervention versus standard care was conducted in three intervention and three control adult surgical wards in an 867-bed public hospital in Cape Town, between March and July 2010; thereafter the MEWS chart was withdrawn. A total of 50 out of 122 nurses in full-time employment participated. From 1,427 case notes, 114 were selected by randomization for assessment. The MEWS chart was implemented in intervention wards. Control wards delivered standard care, without training. Case notes were reviewed two weeks after the trial's completion. Knowledge was assessed in both trial arms by blinded independent marking of written tests before and after training of nurses in intervention wards. Analyses were undertaken with IBM SPSS software on an intention-to-treat basis.

Results: Patients in trial arms were similar. Introduction of the MEWS was not associated with statistically significant changes in responses to clinical deterioration (50 of 57 received no assistance versus 55 of 57, odds ratio (OR): 0.26, 95% confidence interval (CI): 0.05 to 1.31), despite improvement in nurses' knowledge in intervention wards. More patients in intervention than control wards had recordings of respiratory rate (27 of 57 versus 2 of 57, OR: 24.75, 95% CI: 5.5 to 111.3) and recordings of all seven parameters (5 of 57 versus 0 of 57 patients, risk estimate: 1.10, 95% CI: 1.01 to 1.2).

Conclusions: A MEWS chart and training program enhanced recording of respiratory rate and of all parameters, and nurses' knowledge, but not nurses' responses to patients who triggered the MEWS reporting algorithm.

Trial registration: This trial was registered with the Pan African Clinical Trials Registry (identifier: PACTR201309000626545 ) on 9 September 2013.

Show MeSH
Flow diagram of clusters and nurses for the intervention group (MEWS knowledge testing and training program) and control group (only knowledge testing).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
getmorefigures.php?uid=PMC4374204&req=5

Fig2: Flow diagram of clusters and nurses for the intervention group (MEWS knowledge testing and training program) and control group (only knowledge testing).

Mentions: The flow of nurses recruited for the training intervention on an intention-to-treat basis is shown in FigureĀ 2 [16-18]. It was anecdotally reported, after the trial conclusions, that a small number of two to three nurses from control wards were working occasional overtime shifts in intervention wards. A total of 50 nurses participated in pre- and post-knowledge testing (25 in each arm) (Additional file 3). There were 13 Registered Professional Nurses (RPNs) in each trial arm, five Registered Staff Nurses (RSNs) in the intervention arm versus four in the control arm, and seven Registered Nursing Auxiliaries (RNAs) in the intervention arm versus eight in the control arm. One nurse in each of two intervention wards declined to participate in the study.Figure 2


Early warning scoring systems versus standard observations charts for wards in South Africa: a cluster randomized controlled trial.

Kyriacos U, Jelsma J, James M, Jordan S - Trials (2015)

Flow diagram of clusters and nurses for the intervention group (MEWS knowledge testing and training program) and control group (only knowledge testing).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4374204&req=5

Fig2: Flow diagram of clusters and nurses for the intervention group (MEWS knowledge testing and training program) and control group (only knowledge testing).
Mentions: The flow of nurses recruited for the training intervention on an intention-to-treat basis is shown in FigureĀ 2 [16-18]. It was anecdotally reported, after the trial conclusions, that a small number of two to three nurses from control wards were working occasional overtime shifts in intervention wards. A total of 50 nurses participated in pre- and post-knowledge testing (25 in each arm) (Additional file 3). There were 13 Registered Professional Nurses (RPNs) in each trial arm, five Registered Staff Nurses (RSNs) in the intervention arm versus four in the control arm, and seven Registered Nursing Auxiliaries (RNAs) in the intervention arm versus eight in the control arm. One nurse in each of two intervention wards declined to participate in the study.Figure 2

Bottom Line: Control wards delivered standard care, without training.More patients in intervention than control wards had recordings of respiratory rate (27 of 57 versus 2 of 57, OR: 24.75, 95% CI: 5.5 to 111.3) and recordings of all seven parameters (5 of 57 versus 0 of 57 patients, risk estimate: 1.10, 95% CI: 1.01 to 1.2).A MEWS chart and training program enhanced recording of respiratory rate and of all parameters, and nurses' knowledge, but not nurses' responses to patients who triggered the MEWS reporting algorithm.

View Article: PubMed Central - PubMed

Affiliation: Division of Nursing and Midwifery, Department of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Anzio Road, Cape Town, 7925, South Africa. una.kyriacos@uct.ac.za.

ABSTRACT

Background: On South African public hospital wards, observation charts do not incorporate early warning scoring (EWS) systems to inform nurses when to summon assistance. The aim of this trial was to test the impact of a new chart incorporating a modified EWS (MEWS) system and a linked training program on nurses' responses to clinical deterioration (primary outcome). Secondary outcomes were: numbers of patients with vital signs recordings in the first eight postoperative hours; number of times each vital sign was recorded; and nurses' knowledge.

Methods/design: A pragmatic, parallel-group, cluster randomized, controlled clinical trial of intervention versus standard care was conducted in three intervention and three control adult surgical wards in an 867-bed public hospital in Cape Town, between March and July 2010; thereafter the MEWS chart was withdrawn. A total of 50 out of 122 nurses in full-time employment participated. From 1,427 case notes, 114 were selected by randomization for assessment. The MEWS chart was implemented in intervention wards. Control wards delivered standard care, without training. Case notes were reviewed two weeks after the trial's completion. Knowledge was assessed in both trial arms by blinded independent marking of written tests before and after training of nurses in intervention wards. Analyses were undertaken with IBM SPSS software on an intention-to-treat basis.

Results: Patients in trial arms were similar. Introduction of the MEWS was not associated with statistically significant changes in responses to clinical deterioration (50 of 57 received no assistance versus 55 of 57, odds ratio (OR): 0.26, 95% confidence interval (CI): 0.05 to 1.31), despite improvement in nurses' knowledge in intervention wards. More patients in intervention than control wards had recordings of respiratory rate (27 of 57 versus 2 of 57, OR: 24.75, 95% CI: 5.5 to 111.3) and recordings of all seven parameters (5 of 57 versus 0 of 57 patients, risk estimate: 1.10, 95% CI: 1.01 to 1.2).

Conclusions: A MEWS chart and training program enhanced recording of respiratory rate and of all parameters, and nurses' knowledge, but not nurses' responses to patients who triggered the MEWS reporting algorithm.

Trial registration: This trial was registered with the Pan African Clinical Trials Registry (identifier: PACTR201309000626545 ) on 9 September 2013.

Show MeSH