roisin mcloughlin rgn bsc msc centre for nursing and midwifery education, donegal
TRANSCRIPT
Implementing the National Early Warning Score for
Healthcare Assistants (HCA-NEWS) in an Acute Hospital
Roisin McLoughlinRGN BSc MSc
Centre for Nursing and Midwifery Education, Donegal
Organisational change management
development project
Organisational Context
Developing the scope of the HCA role
National HCA NEWS education programme
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Background
To facilitate a process whereby nominated health care assistants
(HCAs) would be educated to competently measure, record and
communicate patients vital signs including calculating and recording a
total EWS using the Adult Patient Observation Chart, and facilitated to
safely perform these skills.
OBJECTIVES To provide the National HCA-NEWS Education Programme
Introduce the HCA-NEWS into Clinical Practice
Establish a process to facilitate the HCA to safely perform NEWS
Evaluate the impact of the HCA-NEWS in practice
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Aim
HSE Change Model (2008)
The four key Stages HSE Change Model (2008)
Initiation
Planning
Implementing
Mainstreaming
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Local Ethics Committee Approval 14/10/2014 Literature Review Methodology Force Field Analysis Stakeholder Analysis Consultation with a range of key stakeholders – Clinical
Nurse Managers were key Application and selection process of HCAs – National
Pre Requisites Identifying Registered Nurse Mentors Evaluation Process
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Project Process- Initiation
Literature based on documentation of observations and EWS published during 2009
– 2014 which included studies of HCAs and EWS or track and trigger systems within
a general ward setting.
The electronic databases searched included CINAHL, Cochrane, Medline, Pub Med
and Web of Science.
Limited results: Search was expanded to include literature published from 2005 –
2014
A total of 33 articles were selected. Grey literature sources were searched and 10
relevant government agencies documents were used.
Exclusion
Papers with reference to Maternity early warning scores (MEWS) or Paediatric
(PEWS) and EWS within critical care areas
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Literature Review
Patient Safety and Suboptimal Care
Monitoring and Recording Vital Signs and EWS
Education and Training in Vital Signs monitoring and EWS
Delegation and Competence
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KeyThemes
PLANNING
Letter of invitation to HCAs
Information on project
Signed Consent
Pre Questionnaire
Project Timeline: October 2014- April 2015
Review Guidelines and Policy
Planning and Implementation
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Summary of the data collection methods utilised in this project
Delivery of HCA NEWS Education programme
Six weeks supervised practice & skills demonstration in the
clinical area.
Independent Self Audit over a two month period
HCAs to complete an ISBAR record of Documentation and
Communication
A full set of vital signs must be recorded each time and
documented on the EWS Observation Chart.
Every entry must be dated (Day, Month and Year), timed
(using the 24hr Clock), complete with Initials & Grade HCA.
Implementing the Change
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Healthcare Assistants’ Measuring, Recording and Communicating Patients’ Vital Signs, incorporating the National Early Warning Score (Adult), using the Patient Observation Chart. Skill Demonstration and Competence Assessment Record
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Independent Self Audit
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After successfully being assessed competent on 10 occasions, the HCA could measure the vital signs as delegated under the delegation procedure. Each time they measured and recorded vital signs, they maintained a self audit form.
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Self Audit of EWS Recordings
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Days (08:00 - 17:00)Evenings (17:00 - 21:00)Nights(21:00 - 08:00)
On recording a EWS of greater than 2 or a new score of 1
the HCA was asked to complete this record which was used
to communicate a patients total EWS to the RN. Both the
HCA and the RN signed the record and this was placed in
the Nursing documentation.
Education was also necessary for nurse mentors so that
they were familiar with the Delegating Procedure and the
scope of the project.
These education sessions took place on the six clinical
areas
Record of Documentation and Communication
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Health Care Assistant Report of Early Warning Score (EWS)EWS Score: Date__/___/_____ Time________
Trigger (please tick)
Respiratory rate: Verbally Reported to:
O2 saturations: Grade__________________ Signature____________________Oxygen therapy: Nurse PIN________________ Inspired O2: Heart rate: Reported By: Systolic BP: Grade___________________
_Signature____________________
Conscious level Registration No.:__________ Temperature:
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Reporting documentationA system for the HCAs to report findings to the Registered Nurse and to document in the nursing record was developed in Tallaght Hospital and reproduces with kind permission.A report sheet was developed, designed to be printed on sticky paper and placed into the nursing record when complete.
Tallaght Hospital Dublin
Nursing and Midwifery Quality Care Metrics Results
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December 2014, February 2015, March 2015
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FOCUS GROUS: Overview of themes and sub themes
Positive impact on staff
Improved communication
Improved Teamwork
Increased Confidence in Caring
More involvement with the patient
Created more awareness
Value of HCA reinforced
The benefits to the patients mostly found at night time where
it was felt that the night duty role is more clearly defined
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Organisational Impact
FETAC/QQI FET Level 5 Trained HCAs versus HCAs
Skill Mix: Deployment of trained Staff Planning rotas;
Compromising skill mix
Delegation and Competence
Competing work - Lack of practice opportunities on day
shifts e.g. Student nurses
Need to maintain skill through regular engagement in
practice
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Challenges identified in the focus groups
The RN continues monitoring and supervising the HCA to demonstrate, develop and maintain competency in undertaking, recording, totaling, and communicating a patients’ vital signs and EWS. This will ensure that skills are maintained and are embedded in safe practice.
Continuous evidence in the workplace to demonstrate that: – Patients needs are the priority and patient centred care is evident – Staff are empowered and committed - Policy, protocols and guidelines is adhered to – Quality Standards and goals are achieved (individual, team,
organisational effectiveness) A review of the effectiveness of the HCAs role in undertaking
the skill of HCA-NEWS is completed at local and national level.
Recommendations
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Ongoing audit and evaluation should continue to determine - Totalling of EWS and the completeness of observation
charts - That patients have a minimum of 12hourly observations
recorded - Increased monitoring as per clinical protocol is adhered to
- That the skill has been undertaken by the right person in accordance with the patients’ condition
Standardisation of HCA’s recording and documenting clinical practices in nursing documentation and patients’ charts is used to record patient information.
There is a need for all HCAs to be trained to the same level to maintain standards and ensure clarity of roles and
responsibilities.
Recommendations
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For further information please contact [email protected]
References available on request
Dissertation available on [email protected]
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Thank you