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Impact of a standardized nurse observation protocol including MEWS after Intensive Care Unit discharge

  • K. De Meester
    Correspondence
    Corresponding author at: Antwerp University Hospital, Wilrijkstraat 10, 2650 Edegem, Belgium. Tel.: +32 3 821 36 88.
    Affiliations
    Antwerp University Hospital, Wilrijkstraat 10, 2650 Edegem, Belgium

    Faculty of Medicine and Health Sciences, Division of Nursing and Midwifery Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium
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  • T. Das
    Affiliations
    Antwerp University Hospital, Wilrijkstraat 10, 2650 Edegem, Belgium
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  • K. Hellemans
    Affiliations
    Antwerp University Hospital, Wilrijkstraat 10, 2650 Edegem, Belgium
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  • W. Verbrugghe
    Affiliations
    Department of Critical Care Medicine, Antwerp University Hospital, Wilrijkstraat 10, 2650 Edegem, Belgium

    Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium
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  • P.G. Jorens
    Affiliations
    Department of Critical Care Medicine, Antwerp University Hospital, Wilrijkstraat 10, 2650 Edegem, Belgium

    Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium
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  • G.A. Verpooten
    Affiliations
    Department of Nephrology, Antwerp University Hospital, Wilrijkstraat 10, 2650 Edegem, Belgium

    Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium
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  • P. Van Bogaert
    Affiliations
    Antwerp University Hospital, Wilrijkstraat 10, 2650 Edegem, Belgium

    Faculty of Medicine and Health Sciences, Division of Nursing and Midwifery Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium
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      Abstract

      Background

      Analysis of in-hospital mortality after serious adverse events (SAE's) in our hospital showed the need for more frequent observation in medical and surgical wards. We hypothesized that the incidence of SAE's could be decreased by introducing a standard nurse observation protocol.

      Aim

      To investigate the effect of a standard nurse observation protocol implementing the Modified Early Warning Score (MEWS) and a color graphic observation chart.

      Methods

      Pre- and post-intervention study by analysis of patients records for a 5-day period after Intensive Care Unit (ICU) discharge to 14 medical and surgical wards before (n = 530) and after (n = 509) the intervention.

      Results

      For the total study population the mean Patient Observation Frequency Per Nursing Shift (POFPNS) during the 5-day period after ICU discharge increased from .9993 (95% C.I. .9637–1.0350) in the pre-intervention period to 1.0732 (95% C.I. 1.0362–1.1101) (p = .005) in the post-intervention period. There was an increased risk of a SAE in patients with MEWS 4 or higher in the present nursing shift (HR 8.25; 95% C.I. 2.88–23.62) and the previous nursing shift (HR 12.83;95% C.I. 4.45–36.99). There was an absolute risk reduction for SAE's within 120 h after ICU discharge of 2.2% (95% C.I. −0.4–4.67%) from 5.7% to 3.5%.

      Conclusion

      The intervention had a positive impact on the observation frequency. MEWS had a predictive value for SAE's in patients after ICU discharge. The drop in SAE's was substantial but did not reach statistical significance.

      Keywords

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