Electronic poster

D.J. Moore1, N. Young1, J.S. McNeill1, C. Davidson1, A. Howie2, S. Dummer2 
1New Royal Infirmary of Edinburgh, Critical Care, Edinburgh, United Kingdom, 2New Royal Infirmary of Edinburgh, Edinburgh, United Kingdom 
Barcelona 2010
INTRODUCTION. Most cardiopulmonary arrests are preceded by deterioration in physiological parameters1. Physiological scoring systems have been developed to attempt to identify patients at risk of deterioration, who may require medical intervention or an increased level of care2. The Scottish Early Warning Score (SEWS) requires the measurement of respiratory rate, oxygen saturation, temperature, systolic blood pressure, heart rate and neurological status. If the score is 4 or more then medical assessment should occur. The National Institute of Clinical Excellence recommends that all hospital inpatients should be monitored using a physiological scoring system at least every 12 hours3.
OBJECTIVES. To examine the SEWS chart of every hospital inpatiet in the Royal Infirmary of Edinburgh during one day and to assess whether the necessary physiological parameters had been recorded at last assessment. To determine if practice had improved following an identical study 2 years previously.
METHODS. Data were collected from SEWS charts of 601 patients from 20 wards in the Royal Infirmary of Edinburgh during one day. Patients in the Emergency Department, Critical Care and Day Admissions were excluded. We recorded whether or not each parameter had been documented at the last entry, whether the total SEWS score had been calculated correctly, and whether appropriate action had been taken.
RESULTS. All physiological parameters required to calculate SEWS were recorded in 504/601 (83.86%) of patients. In 2007, only 231/595 (38.8%) of patients had all of the SEWS components recorded. Blood pressure 597/601(99.3%) and heart rate 593/601(98.6%) were recorded more frequently than other physiological parameters. Respiratory rate was the least well recorded 533/601 (92%), although there was an improvement from the previous study where it had only been recorded on 289/595 (48.6%) of occasions.
CONCLUSIONS. There has been a marked improvement in the overall recording of SEWS since the previous study. It is of concern that respiratory rate was again the least well recorded parameter as this has been shown to be the best physiological predictor of impending cardiopulmonary arrest1,4. This may be because respiratory rate is not provided by the automated monitoring devices available on the general wards in our hospital, and must be calculated manually. The improvement in the recording of SEWS in the last 2 years is likely to be the result of nurse training initiatives and self-auditing implemented in response to the previous study in 2007.
1 Schein RM et al. Clinical antecedents to in-hospital cardiopulmonary arrest. Chest 1990; 98: 1388-92
2 Morgan RJM et al. An Early Warning System for detecting developing critical illness. Clin. Intens Care 1997; 8 :100.
3 http://www.nice.org.uk/nicemedia/pdf/CG50Full Guidance.pdf
4 Fieselmann JF et al. Respiratory rate predicts cardiopulmonary arrest for internal medicine patients. J Gen Intern Med 1993; 8: 354-60.
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