Measuring adherence among nurses one year after training in applying the Modified Early Warning Score and Situation-Background-Assessment-Recommendation instruments

Background: Patients with a cardiac arrest or unplanned intensive care admission show gradual decline in clinical condition preceding the event. This can be objectified by measuring the vital parameters and subsequently determining the Modified Early Warning Score (MEWS). Contact with the physician by nurses may be structured using the Situation-Background-Assessment-Recommendation (SBAR) communication instrument. The aim of our study was to evaluate whether nurses trained in the use of MEWS and SBAR tools were more likely to recognize a deteriorating patient.

Design and setting: This prospective quasi-experimental trial in the Academic Medical Center in Amsterdam, the Netherlands included three medical and three surgical wards.

Interventions: A group of 47 trained and 48 non-trained nurses were presented with a case of a deteriorating patient, and subsequent assessment and actions regarding the patient case were measured.

Results: Of the trained nurses, 77% versus 58% of the non-trained group assessed the patient immediately. On subsequent assessment of the patient, respiratory rate was measured twice as frequently (53% trained versus 25% non-trained, p=0.025). No differences were found in the measurement of other vital parameters. The MEWS was determined by 11% of trained nurses. Subsequent notification of the physician was performed by 67% of the trained versus 43% of the non-trained nurses. The SBAR communication tool was used by only one nurse.

Conclusions: Trained nurses are able to identify a deteriorating patient and react more appropriately. However, despite rigorously implementing MEWS/SBAR methodology, these tools were rarely used.