| Popis: |
This quality improvement investigation explored the effectiveness of implementing the National Early Warning Score (NEWS) as a screening tool for detecting early indicators of sepsis in medical oncology patients. The original NEWS (Smith et al., 2013) was modified to account for changes in physiologic components associated with sepsis. Seven parameters were included as separate items, and rubrics were identified for scoring each item to determine a composite score (i.e., the NEWS). A “paper protocol” was designed for nurses as part of every 4 hour monitoring; a NEWS value of ≥ 6 required an assessment by a medical team and institution of a sepsis treatment bundle. Following a series of pilot studies that showed the NEWS to accurately predict sepsis (92% at time of screening; 42% 4 hours prior to screening), unit-wide implementation of the NEWS plus treatment bundle occurred March 1, 2015. Comparison data of patients over six months (March – August) on the same medical oncology units with an ICD of sepsis, but a year earlier (pre-NEWS, 2014), were used to calculate a proxy NEWS value. Of 3,882 paper protocol records of patients, 32 preNEWS and 26 post-NEWS patients had NEWS > 6 and were evaluated for differences in demographic and clinical characteristics. The post-NEWS group averaged 10 years younger than the comparison group (p < .01), had fewer patients suffering from hypertension or Type II diabetes mellitus (though more had chronic obstructive iv pulmonary disease), and had different cancer profiles. More pre-NEWS patients (89%) were categorized in severe sepsis compared to 69% pre implementation (p < .073). No differences were found in the time to treatment (0 – 60 minutes for 50% post-NEWS group vs. 47% pre-NEWS group). Five patients died in the post-NEWS group; 9 died in the pre-NEWS group. Analysis of NEWS values 4 hours before and at time of NEWS alert demonstrated no statistically significant difference, indicating missed opportunities to initiate medical team response and initiation of treatment bundle. Findings indicate the need for additional staff and provider education to ensure adherence to all protocol components to avoid “missed” alerts. Additionally, a computerized tool or application should be built into the electronic medical record for accurate real time sepsis detection. Most importantly, the NEWS tool enhanced awareness of screening for sepsis. |
