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Enhancing Nurses' Capability to Promptly Escalate Care Using the Early Warning Score: A Quality Improvement
Joyce Er1, Emily Ang, Lai Theng Yue
1Author Affiliations: Nursing Department, Alexandra Hospital, Singapore (Drs Er, Ang, and Ms Yue); Duke University School of Nursing, Durham, North Carolina (Dr Thornlow).
Background:
Clinical deterioration in general ward patients is largely preventable with early recognition of abnormal vital signs and prompt escalation of care.
Local Problem:
Limited knowledge of the early warning score (EWS) and an inability to recognize and respond to clinical deterioration among general ward nurses led to delays in escalation of care.
Methods:
This quality improvement project used iterative Plan-Do-Study-Act cycles. Outcomes included knowledge, EWS protocol compliance, and care escalation for patients with an EWS score ≥5 to prevent further deterioration.
Interventions:
A mandatory educational program was implemented with Plan-Do-Study-Act cycles to test and refine practice changes.
Results:
Nurses' knowledge improved significantly post-education (P < .001). EWS protocol compliance and care escalation increased.
Conclusions:
EWS education improved nurses' compliance with protocols and escalation of care, supporting early recognition of clinical deterioration and prevention of serious adverse events.
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