Evaluation of the Early Warning System at Banner Desert Medical Center
AdvisorGephart, Sheila M.
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PublisherThe University of Arizona.
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AbstractPurpose: The aim of this project was to evaluate data from a survey sent to nurses in regards to the current practices and workflow of the Early Warning System (EWS) currently in use at Banner Health. Methods: A descriptive cross-sectional design was used to collect feedback from Registered Nurses. The survey was open between February and March of 2016. Likert style and open-ended questions demonstrate evidence supporting the following study questions: 1) What are the barriers to documentation that triggers the EWS? 2) To what extent is the EWS useful and usable? 3) What were the features of the EWS implementation? Results: Findings demonstrated three barriers associated with EWS protocol compliance to include increased workload (78%), previous negative responses from providers (62%), and alert fatigue (48%). Provider responsiveness to notification of the Early Warning Score was shown to be effective "most of the time" and "about half of the time" at 71%, with 12% indicating "sometimes" and "never". Deployment of the Rapid Response Team (RRT) when indicated by EWS algorithm showed only 9 (14%) of nurses always call the RRT, 7 (11%) call about half the time, and 16% indicated they never use the RRT. "Real time" charting occurred 50-75% or less than 50% of the time for 96% of respondents. Open ended questions support recommendations for future practice to include: implementation of a pop up alert for easy recognition of changes in EWS, tailoring parameters based on individual patient characteristics, automatic direct paging to medical providers, and elimination of the level of consciousness parameter. A validated usability survey provided data with a mean response rate (n=58). Nurses (84%) agree the EWS is useful and usable. Ease of use, efficiency, and comfort with EWS software showed 90% agree. System interface responses demonstrate 23% dislike using the interface, and 21% felt the system interface was unpleasant.Conclusions: Findings demonstrate EWS system usability and usefulness. Recommendations for improvement include implementation of a "pop up" alert for easy recognition of changes in the Early Warning Score and/or automatic direct paging to medical providers and nursing will increase effective use. Barriers to EWS protocol documentation include increased workload, previous negative response from providers, and alert fatigue. "Real time" documentation of physiological parameters is essential to successful triggering of an Early Warning Score.
Degree ProgramGraduate College