How nurses use National Early Warning Score and Individual Early Warning Score to support their patient risk assessment practice: A fieldwork study.
Caroline S Langkjaer, Karin Bundgaard, Gitte Bunkenborg and 4 others
PMID 36541263WHAT IT FOUND
Nurses used early warning scores to plan monitoring and spot deterioration, but often adapted them to ward routines.
Nurses said score adjustment gave them autonomy and a way to signal concern. Delegating scoring to less experienced staff risked missing information.
Key findings
01Nurses used NEWS scores and scheduled next assessment times to plan care, but said they still had to see the patient to form a real impression.
02NEWS was adapted to ward routines: nurses sometimes measured more often than required and sometimes prioritised other nursing tasks over protocol timing.
03Nurses said I-EWS adjustment let them signal concern and include clinical assessment, but some avoided adjusting because they feared missing warning signs or accepting responsibility.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Only day and evening shifts were observed, so night-shift use of NEWS and I-EWS was not captured. The nurses who agreed to be observed may have had particular views about early warning systems. Patients and public were not involved, so the study does not describe how patients experienced the risk assessment. The nurses knew they were being observed, which may have influenced their behaviour. The authors were nurses or physicians with insider knowledge, which can help access but may also mean some routine practices were taken for granted.
Declared interests
The authors declared no conflicts of interest. The work was supported by research grants from Copenhagen University Hospital, North Zealand and Laerdal Foundation, and the funders had no role in the conduct of the research.
The easy way to misread this
Do not conclude that I-EWS improves patient safety. The study observed nurses' practices and perceptions, not patient outcomes.