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97-659 / The National Early Warning Score (NEWS) and associated education programme for the early detection and management of patient deterioration.

Ireland
GOP Information  
 
Organisation sharing the GOP
Related practices from PaSQ database
Health Service Executive (HSE)

Topic

Clinical guidelines or pathways
Quality improvement project
Category
Early warning
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GOP Description
 
Implementation level
National
Clinical settings
The NEWS and associated eduction programme has been implemented in 83% of acute hospitals in Ireland. The remaining hospitals have commenced training their staff for implementation of the initiative.
Objectives
The overall aim of the NEWS project was to develop one integrated solution for a NEWS and associated education programme. This initiative promotes the early detection and timely management of deterioration in patients’ condition to improve outcomes for patients, reducing cardiac arrests, unplanned admission to ICU and unexpected death.
Population
All adult patients in acute hospitals (excluding obstetric and paediatric patients). Responsibility for implementing the NEWS applies to healthcare professionals, doctors, nursse and allied health professionals in conjunction with NEWS committees / groups in acute hospitals, and managers in hospitals or groups of hospitals.
Methods
 
Methodology
A national lead was identified.
Multi-disciplinary National Governance / National Clinical Guideline development and Advisory groups were set up.
Evidence was gathered to aid in the decision making process. This included:
a) A baseline audit of early warning scores and education programmes in use in acute hospitals. nationally.
b)    A strengths, weaknesses, opportunities, threats analysis and risks identification.
c)    A systematic search and review of literature.
d)    A comparative analysis of education programmes
e)    An economic impact study.
Levels of evidence were linked to the recommendations of the project.
The NEWS and adapted COMPASS Education Programme were signed off at senior level.
International experts were consulted.
The programme was updated following the discovery of new evidence on early warning scores – the update also included the early detection and treatment of sepsis and a National Patient Observation Chart.
Barriers and enablers for implementation were identified.
A National Clinical Guideline was developed.
Audit and evaluation recommendations with specific criteria were identified.
Programme Launch took place in March 2012.
A website was developed.
Implementation has progressed in 80% of acute hospitals.
Timeframe implementation
Full implementation is planned for the end of 2013 in all acute hospitals in Ireland providing acute care.
Implementation tools available
National Contact person provides support.
Regional and Local contacts identified.
Tools:
‘Train the Trainer’ programme.
Training in all acute hospitals.
An Education Toolkit.
Education Facilitators Guide.
Education Equipment List.
Education Programme Equipment List.
Education Programme Evaluation Forms.
Training Manual.
Interactive CD.
Quiz Questions.
Powerpoint Presentation for Education Programme Facilitator.
Powerpoint Presentation handouts.
Case Study Examples.
Implementation Resources.
Sample Project Plan.
National Patient Observation Chart.
Deteriorating Patient Flow Chart for display in wards.
ISBAR Communication Tool Chart Guide.
The issues log on email to allow for feedback.
The material may be downloaded free of charge from:
http://www.hse.ie/go/nationalearlywarningscore/
Implementation cost
Implementation costs were reduced by expert management of staff release to attend the education programme. This was managed locally. All materials were made available on the website. Initial funding of education materials was supported by the Office of Nursing and Midwifery Services Director - €18,000.
Results
 
Method used to measure the results
Figures were obtained from acute hospital sites on cardiac arrest figures pre and post implementation.
Results
Overall preliminary results indicate an average of 30% reduction of cardiac arrests. This is in line with international data (Buist) and (Bellomo).
Analysis of the results
Simple statistics were used to provide figures on the cardiac rate before and after implementation of the NEWS. Some caution was expressed as to the attributing this reduction solely to the introduction of the NEWS.
Implementation barriers
 
Did you find implementation barriers?
Yes
Please describe implementation barriers
The main barrier for implementation as expected was resistance to a change in culture in acute hospitals, from a small number of staff.
Describe the strategies used to overcome the barriers (If needed)
Two national conferences organised – international and national speakers.
Multi-disciplinary groups in acute hospitals were visited.
Key people, acting as champions on sites were identified.
Continuous dialogue was maintained with staff.
Quarterly audits completed outlining national progress.
An ‘issues log’ set up on email, to address queries.
Good news stories were communicated.
International evidence and updated information was provided.
The Health Information and Quality Authority (the healthcare regulator in Ireland) and the Clinical Indemnity Scheme (part of the State Claims Agency) recommend implementation.
These strategies has made implementation a much smoother process.
Other information
 
Other information about the GOP that you would like to add (Link or attached document)
Ireland is the first known country to have agreed a NEWS.
The National Clinical Guideline for the NEWS is the first clinical guideline to be endorsed by the Minister for Health which was recommended by the National Clinical Effectiveness Committee in the Department of Health.
The aim of the Committee is to provide a framework for national endorsement of clinical guidelines and audit to optimise patient care.
The NEWS is a significant development in the Irish healthcare context as part of a generational change in how acute hospitals deliver care by standardisation of the assessment of the assessment of acute illness severity, enabling a more timely response using a common language.
The project won 3 awards in 2012:
The Taoiseach’s (Prime Minister) Award for the Public Service Excellence Awards, The (Biomnis) Health Innovation Award – Patient Safety Category and the Irish Medical Times Award – Excellence in Healthcare Management.
The National Patient Observation Chart was awarded a commendation at the UK Society of Acute Medicine Conference in Manchester (Oct 2012).
The awards recognise the hard work and commitment of nurses, doctors, allied health professionals and managers committed to promoting patient safety and quality of care.

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Contact information
 
Name: Elaine O' Connor
Position/function: Programme Manager
Department: Safety and Quality Improvement Directorate
Organisation: Health Information and Quality Authority
City: Dublin
Country: Ireland
Region: Leinster
E-mail: eoconnor@hiqa.ie
Phone: 00 353 1 814 7435
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