Early warning scoring systems versus standard observations charts for wards in South Africa: a cluster randomized controlled trial

dc.contributor.authorKyriacos, Una
dc.contributor.authorJelsma, Jennifer
dc.contributor.authorJames, Michael
dc.contributor.authorJordan, Sue
dc.date.accessioned2015-04-24T06:38:22Z
dc.date.available2015-04-24T06:38:22Z
dc.date.issued2015-03-20
dc.date.updated2015-03-25T19:03:15Z
dc.description.abstractBackground: On South African public hospital wards, observation charts do not incorporate early warning scoring (EWS) systems to inform nurses when to summon assistance. The aim of this trial was to test the impact of a new chart incorporating a modified EWS (MEWS) system and a linked training program on nurses’ responses to clinical deterioration (primary outcome). Secondary outcomes were: numbers of patients with vital signs recordings in the first eight postoperative hours; number of times each vital sign was recorded; and nurses’ knowledge. Methods/design: A pragmatic, parallel-group, cluster randomized, controlled clinical trial of intervention versus standard care was conducted in three intervention and three control adult surgical wards in an 867-bed public hospital in Cape Town, between March and July 2010; thereafter the MEWS chart was withdrawn. A total of 50 out of 122 nurses in full-time employment participated. From 1,427 case notes, 114 were selected by randomization for assessment. The MEWS chart was implemented in intervention wards. Control wards delivered standard care, without training. Case notes were reviewed two weeks after the trial’s completion. Knowledge was assessed in both trial arms by blinded independent marking of written tests before and after training of nurses in intervention wards. Analyses were undertaken with IBM SPSS software on an intention-to-treat basis. Results: Patients in trial arms were similar. Introduction of the MEWS was not associated with statistically significant changes in responses to clinical deterioration (50 of 57 received no assistance versus 55 of 57, odds ratio (OR): 0.26, 95% confidence interval (CI): 0.05 to 1.31), despite improvement in nurses’ knowledge in intervention wards. More patients in intervention than control wards had recordings of respiratory rate (27 of 57 versus 2 of 57, OR: 24.75, 95% CI: 5.5 to 111.3) and recordings of all seven parameters (5 of 57 versus 0 of 57 patients, risk estimate: 1.10, 95% CI: 1.01 to 1.2). Conclusions: A MEWS chart and training program enhanced recording of respiratory rate and of all parameters, and nurses’ knowledge, but not nurses’ responses to patients who triggered the MEWS reporting algorithm. Trial registration: This trial was registered with the Pan African Clinical Trials Registry (identifier: PACTR201309000626545) on 9 September 2013.
dc.identifier.apacitationKyriacos, U., Jelsma, J., James, M., & Jordan, S. (2015). Early warning scoring systems versus standard observations charts for wards in South Africa: a cluster randomized controlled trial. <i>Trials</i>, http://hdl.handle.net/11427/12695en_ZA
dc.identifier.chicagocitationKyriacos, Una, Jennifer Jelsma, Michael James, and Sue Jordan "Early warning scoring systems versus standard observations charts for wards in South Africa: a cluster randomized controlled trial." <i>Trials</i> (2015) http://hdl.handle.net/11427/12695en_ZA
dc.identifier.citationKyriacos, Una; Jelsma, Jennifer; James, Michael and Jordan, Sue (2015) Early warning scoring systems versus standard observations charts for wards in South Africa: a cluster randomized controlled trial. Trials. 16(1):103-118.
dc.identifier.ris TY - Journal Article AU - Kyriacos, Una AU - Jelsma, Jennifer AU - James, Michael AU - Jordan, Sue AB - Background: On South African public hospital wards, observation charts do not incorporate early warning scoring (EWS) systems to inform nurses when to summon assistance. The aim of this trial was to test the impact of a new chart incorporating a modified EWS (MEWS) system and a linked training program on nurses’ responses to clinical deterioration (primary outcome). Secondary outcomes were: numbers of patients with vital signs recordings in the first eight postoperative hours; number of times each vital sign was recorded; and nurses’ knowledge. Methods/design: A pragmatic, parallel-group, cluster randomized, controlled clinical trial of intervention versus standard care was conducted in three intervention and three control adult surgical wards in an 867-bed public hospital in Cape Town, between March and July 2010; thereafter the MEWS chart was withdrawn. A total of 50 out of 122 nurses in full-time employment participated. From 1,427 case notes, 114 were selected by randomization for assessment. The MEWS chart was implemented in intervention wards. Control wards delivered standard care, without training. Case notes were reviewed two weeks after the trial’s completion. Knowledge was assessed in both trial arms by blinded independent marking of written tests before and after training of nurses in intervention wards. Analyses were undertaken with IBM SPSS software on an intention-to-treat basis. Results: Patients in trial arms were similar. Introduction of the MEWS was not associated with statistically significant changes in responses to clinical deterioration (50 of 57 received no assistance versus 55 of 57, odds ratio (OR): 0.26, 95% confidence interval (CI): 0.05 to 1.31), despite improvement in nurses’ knowledge in intervention wards. More patients in intervention than control wards had recordings of respiratory rate (27 of 57 versus 2 of 57, OR: 24.75, 95% CI: 5.5 to 111.3) and recordings of all seven parameters (5 of 57 versus 0 of 57 patients, risk estimate: 1.10, 95% CI: 1.01 to 1.2). Conclusions: A MEWS chart and training program enhanced recording of respiratory rate and of all parameters, and nurses’ knowledge, but not nurses’ responses to patients who triggered the MEWS reporting algorithm. Trial registration: This trial was registered with the Pan African Clinical Trials Registry (identifier: PACTR201309000626545) on 9 September 2013. DA - 2015-03-20 DB - OpenUCT DO - 10.1186/s13063-015-0624-2 DP - University of Cape Town J1 - Trials LK - https://open.uct.ac.za PB - University of Cape Town PY - 2015 T1 - Early warning scoring systems versus standard observations charts for wards in South Africa: a cluster randomized controlled trial TI - Early warning scoring systems versus standard observations charts for wards in South Africa: a cluster randomized controlled trial UR - http://hdl.handle.net/11427/12695 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/12695
dc.identifier.urihttp://dx.doi.org/10.1186/s13063-015-0624-2
dc.identifier.vancouvercitationKyriacos U, Jelsma J, James M, Jordan S. Early warning scoring systems versus standard observations charts for wards in South Africa: a cluster randomized controlled trial. Trials. 2015; http://hdl.handle.net/11427/12695.en_ZA
dc.language.rfc3066en
dc.publisherBioMed Centralen_ZA
dc.publisher.departmentDivision of Nursing and Midwiferyen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsCreative Commons Attribution 4.0 International (CC BY 4.0)en_ZA
dc.rights.holderKyriacos et al.; licensee BioMed Central.
dc.rights.urihttps://creativecommons.org/licenses/by/4.0/
dc.sourceTrials
dc.source.urihttp://www.trialsjournal.com/en_ZA
dc.subject.otherCluster randomized trialen_ZA
dc.subject.otherDeveloping countryen_ZA
dc.subject.otherIn-service trainingen_ZA
dc.subject.otherMonitoring (physiological)en_ZA
dc.subject.otherPragmatic randomized controlled trialen_ZA
dc.subject.otherVital signsen_ZA
dc.subject.otherScoring systemsen_ZA
dc.titleEarly warning scoring systems versus standard observations charts for wards in South Africa: a cluster randomized controlled trial
dc.typeJournal Article
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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