Volume 7 Supplement 2

23rd International Symposium on Intensive Care and Emergency Medicine

Open Access

Comparison of general medical and general surgical nursing intervention following Early Warning Score triggers

  • S Ingleby1 and
  • D Conway1
Critical Care20037(Suppl 2):P237

https://doi.org/10.1186/cc2126

Published: 3 March 2003

Introduction

The Early Warning Score (EWS) [1] has been delivered within the trust for 2 years. In our institution, the EWS protocol has been modified to allow a nurse intervention when EWS = 3 (Appendix 1). The aim of the study was to look at the efficacy of nursing interventions in medical and surgical patient groups.

Method

Data were prospectively collected within the surgical and medical wards over a period of 10 weeks. We recorded information for any patient who triggered EWS ≥ 3. The person performing the first intervention and the prevention of further triggers was noted.

Results

Nurses caring for acutely unwell medical patients were able to intervene in 60% of initial triggers without having to call for a doctor (Table 1). These interventions successfully reduced the score in 60% of cases. By contrast, in the surgical group, 16% of triggers were initially dealt with by the nursing staff, and these interventions were successful in 60% of cases.

Table 1

 

Patients on medical ward

Patients on surgical ward

Fisher's exact test, P

Total triggering

500

398

 

Nurse therapy as first intervention

301 (60%)

42 (16%)

< 0.0001

EWS successfully reduced by nurse therapy

188 (62%)

42 (61%)

NS

Patients who retrigger following nurse therapy

110

18

NS

Appendix 1

Early Warning Score used in Central Manchester and Manchester Children's University NHS Trust

 

3

2

1

0

1

2

3

HR

 

≤ 40

40–50

51–100

101–110

111–129

≥ 130

SBP

≤ 70

71–80

81–100

101–199

 

≥ 200

 

RR

 

≤ 8

 

9–14

15–20

21–29

≥ 30

Temperature (°C)

 

≤ 35.0

35.1–36.0

36.1–37.9

≥ 38–38.9

≥ 39

 

CNS

   

Alert

Voice

Pain

Unconscious

Alert, patient is alert and orientated; Voice, patient responds to voice; Pain, patient responds to painful stimuli; Unconscious, patient is unconscious.

Conclusion

A number of factors could explain these differences: the intensive education package that accompanied the introduction of the score into medicine, differences within the patient groups, and the use of medical ward nurses assisting in the implementation of the score into their areas. Nursing intervention appears effective as first-line treatment for a trigger in many medical patients and we believe it is a useful part of the EWS protocol.

Authors’ Affiliations

(1)
Intensive Care Unit, Manchester Royal Infirmary

References

  1. Morgan RJM, Williams F, Wright MM: An early warning scoring system for detecting developing critical illness [abstract]. Clin Int Care 1997, 8: 100.Google Scholar

Copyright

© BioMed Central Ltd 2003

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