A major criticism of the use of early warning system (EWS) algorithms was the potential for decreased use of critical thinking by nurses. Thus, the purpose of this study was to explore nurses’ perceptions of how the use of an EWS that included enhancements aimed at supporting critical thinking impacted their practice.
Recognizing and avoiding clinical deterioration of medical/surgical patients through early identification is critical to improved patient outcomes. Early warning systems (EWS) are designed to identify subtle changes in patient condition that may herald clinical deterioration and to trigger an alert, leading to earlier intervention. Research has demonstrated nurse satisfaction and earlier recognition of signs of deterioration …show more content…
These systems use objective physiological measures of patient vital signs to alert nurses to subtle changes. Pre-determined normal values are established and receive zero points, while deviation either above or below established parameters, receive increasing point values. Scores are determined by the sum of each measured parameter and are correlated to a hospital’s protocol. For a high aggregate score, the nurse is directed to consider an intervention, such as escalating care by calling a rapid response team. EWS scores were originally designed for paper, requiring periodic hand-scoring of multiple variables. But the time and effort required made it burdensome for nursing staff. Leveraging technology, it is now possible for EMRs to analyze values entered, display an updated EWS score each time new data is entered, and trigger an alert in the EMR (Kho et al., 2007). Use of automated EWS was found to significantly reduce the “onset to recognition time” for deterioration (Jones, 2013; Swartz, 2011) and improve nurse satisfaction (Jones, 2013). But knowledge of deterioration is not the only concern, as appropriate response to the alert is of equal importance. Effective action is necessary, which requires critical thinking. Nurses must evaluate clinical values then consider them in the context of the clinical assessment …show more content…
This new functionality incorporated not only a EWS and intervention algorithm but also aggregated key data points into a single view and utilized smartform technology and autoflexing to guide nursing assessment and provide clinical decision support. A pre-login screen was also been created. Leveraging EMR functionality in this way is novel and its impact on nursing practice is unknown. This study explored nurse experience in using an EMR-enhanced EWS. EMRs can be enhanced to not only trigger EWS alerts but to also increase situational awareness. Utilizing an iterative approach to collate data and guide critical thinking and intervention may decrease time to recognition and intervention. Early recognition of clinical deterioration may lead to improved patient outcomes, improved nurse workflow, unit teamwork, and staff satisfaction. Understanding nurse perception of the EWS system enhancements and the impact this has on nursing practice is key for directing further EMR process development and improvement. This qualitative study utilized a phenomenological design and interview methodology to explore medical/surgical nurse experience of using an enhanced EMR early warning system in order to understand impact it has on nursing practice. Findings from this study will be used to develop and/or revise EMR functionality to best support use of an EMR-enhanced EWS within nursing
Recognizing and avoiding clinical deterioration of medical/surgical patients through early identification is critical to improved patient outcomes. Early warning systems (EWS) are designed to identify subtle changes in patient condition that may herald clinical deterioration and to trigger an alert, leading to earlier intervention. Research has demonstrated nurse satisfaction and earlier recognition of signs of deterioration …show more content…
These systems use objective physiological measures of patient vital signs to alert nurses to subtle changes. Pre-determined normal values are established and receive zero points, while deviation either above or below established parameters, receive increasing point values. Scores are determined by the sum of each measured parameter and are correlated to a hospital’s protocol. For a high aggregate score, the nurse is directed to consider an intervention, such as escalating care by calling a rapid response team. EWS scores were originally designed for paper, requiring periodic hand-scoring of multiple variables. But the time and effort required made it burdensome for nursing staff. Leveraging technology, it is now possible for EMRs to analyze values entered, display an updated EWS score each time new data is entered, and trigger an alert in the EMR (Kho et al., 2007). Use of automated EWS was found to significantly reduce the “onset to recognition time” for deterioration (Jones, 2013; Swartz, 2011) and improve nurse satisfaction (Jones, 2013). But knowledge of deterioration is not the only concern, as appropriate response to the alert is of equal importance. Effective action is necessary, which requires critical thinking. Nurses must evaluate clinical values then consider them in the context of the clinical assessment …show more content…
This new functionality incorporated not only a EWS and intervention algorithm but also aggregated key data points into a single view and utilized smartform technology and autoflexing to guide nursing assessment and provide clinical decision support. A pre-login screen was also been created. Leveraging EMR functionality in this way is novel and its impact on nursing practice is unknown. This study explored nurse experience in using an EMR-enhanced EWS. EMRs can be enhanced to not only trigger EWS alerts but to also increase situational awareness. Utilizing an iterative approach to collate data and guide critical thinking and intervention may decrease time to recognition and intervention. Early recognition of clinical deterioration may lead to improved patient outcomes, improved nurse workflow, unit teamwork, and staff satisfaction. Understanding nurse perception of the EWS system enhancements and the impact this has on nursing practice is key for directing further EMR process development and improvement. This qualitative study utilized a phenomenological design and interview methodology to explore medical/surgical nurse experience of using an enhanced EMR early warning system in order to understand impact it has on nursing practice. Findings from this study will be used to develop and/or revise EMR functionality to best support use of an EMR-enhanced EWS within nursing