Patient safety is a top priority for St George's Healthcare and work is ongoing around the trust to ensure that patients are safe and that any problems around safety are reported timely and effectively.
A key project being undertaken by Deborah Dawson, consultant nurse in critical care, and her team, with support from the simulation unit and Paula McLean, resuscitation service manager, and her team, is work around the 'track and trigger' or 'early warning system' (EWS) tools used to record and report the deterioration of patients.
Early warning systems provide a score for routine observations such as heart rate, respiratory rate and blood pressure. The trust's model also includes urine output, level of consciousness and temperature. Each parameter is scored more highly the further it deviates from 'normal'. The individual score for each parameter is then combined and this provides an aggregated weighted score for each set of observations which can be compared to a trigger tool to highlight patients that should be reviewed.
Although the trust has been using this tool since 2000, a series of audits over 2009/2010 undertaken by Chris Ryan, GICU sister, identified some problems with the completion of the current documentation and poor compliance with the trigger tool.
Following this, a group comprising of ward sisters, matrons and practice educators with representation from intensive care, simulation, resuscitation and patient safety was set up to redesign the charts to provide greater visual clarity of patient deterioration. The charts also include a communication tool known as SBAR (Situation, Background, Assessment, Recommendation) system for communications.
The SBAR tool provides a framework to gather all the necessary information, including the information gained from the EWS, to ensure accurate, confident and timely communication between clinical teams. The SBAR tool also helps staff to consider and anticipate important information that may be needed by colleagues in an emergency situation.
Paula McLean said, "The SBAR and EWS tools help first line responders to recognise and then clearly communicate patient deterioration. A fast response to recognise early patient deterioration gives the patient the best chance for recovery."