Abstract
AIMS: To describe the experience of registered nurses implementing the New Zealand Early Warning Score (NZEWS) escalation pathway in the private surgical setting.
BACKGROUND: Patient deterioration is heralded by antecedent changes in vital signs. To support early detection and response to patient deterioration recognition and response systems (RRS) were introduced. Despite this there remain delays in escalation of care. The reasons for this include human factors, nurse autonomy to make clinical decisions, clinician perception of recognition and response systems and care context factors. The discontinuous on-site presence of medical specialists in private hospitals is a contextual factor of interest to implementation of recognition and response systems that has not been previously explored.
METHODS: A qualitative descriptive approach was utilised. Registered nurses working within the private surgical setting were interviewed using a semi-structured interview technique to explore their experiences implementing the NZEWS escalation pathway in the private hospital setting. Reflexive thematic analysis was applied leading to formation of themes.
FINDINGS: Four themes were developed 1. Ambivalence towards the NZEWS and its application/utility in the private surgical setting; 2. Protocol adherence, escalation hesitation depends on when and to whom you are escalating care; 3. The role of modifications in promoting successful application of escalation protocol; 4. Human factors and successful implementation of escalation protocol.
CONCLUSION: Imperfect implementation of recognition and response systems presents a threat to patient safety, potentially leading to delayed care escalation and failure to rescue. To optimise implementation of RRS there needs to be adequate organisational support for nurses to promote protocol adherence. Increasing nurse clinical decision-making autonomy and reviewing wording on escalation protocols to clarify expectations may improve implementation of NZEWS and promote timely care escalation. Such changes could include using consistent terms within policy documents for the role and scope of senior nurses involved in care escalation. Skilful use of modifications when indicated and providing interprofessional education regarding NZEWS may promote user engagement with the tool. Further research about this issue in different contexts may help inform targeted strategies to improve escalation practices.