Reducing Early Warning System Unreported Events in an Acute Care Setting Using Education and a Communication Tool

Abstract

The inability of the healthcare team to identify and report Early Warning System (EWS) patient events can result in further patient deterioration and delays in providing needed care. The purpose of this DNP Quality Improvement (QI) project was to initiate a QI solution using evidence-based practice (EBP) to address unreported EWS patient events on inpatient medical and surgical units at one healthcare institution. This DNP project instituted education and re-education of staff on EWS and utilized an EWS Communication Tool (ECT) to reduce unreported EWS scores >4 or a score of >2 for a single EWS parameter thereby improving EWS response times and positively influencing patient outcomes. The data collected involved reported and unreported EWS patient events representing pre- and post- QI implementation. Using Social Cognitive Theory (SCT) as a framework and the Model for Improvement, the DNP student provided the medical/surgical staff EWS education, re-education, and the ECT. Data collected revealed that some EWS parameters were more frequently missed than others. Analysis also revealed a significant association between travel nurses in the post-QI implementation period and unreported EWS events. Both factors can be considered when planning future education. A positive finding was the increase in reporting for an EWS score of three in the post-implementation period. Continued implementation of the QI project’s interventions can help sustain this and other encouraging findings.