BACKGROUND: Late identification of deteriorating children undermines timely implementation of life-saving measures to prevent cardiopulmonary arrest (CPA) or death. The Pediatric Early Warning System (PEWS) has been validated for use in pediatric acute care settings for early identification of children at increased risk of physiologic deterioration, yet there is a dearth of evidence of the use of PEWS in primary care. Implementing the PEWS in primary care could guide rural primary care practitioners to early detection and prompt management of deteriorating children. This DNP project evaluated the attitudes and perceptions of rural practitioners towards the implementation of the PEWS scoring tool. METHODS: A cross-sectional descriptive design was conducted using an anonymous online survey via an email listserv. RESULTS: Seventeen practitioners responded to the survey, but only 14 participants met criteria for inclusion – 2 males and 11 females. The sex of one participant was not reported. Participants areas of specialization include 79% specialized in family practice, 79% pediatric specialists 14% and (7%) listed as "Other." Thirty-one percent of participants reported a travel distance of over 60 miles, while 39% reported a travel distance of over 60 miles lasting over 60 minutes via ground from a place of care to a hospital that specializes in the pediatric emergency care, and pediatric care respectively. Although 92% reported they have not heard of the PEWS tool prior to this survey, 54% strongly agree that the PEWS could help prevent cardiopulmonary arrest or death. Similarly, 54% of respondents reported they strongly agree that the PEWS can help identify deteriorating children, while 39% somewhat agree. Over 62% strongly agree that implementing the PEWS is appropriate in primary care, while 31% somewhat agree. Fifty-four percent of participants strongly agree they could use the PEWS tool in their practice. DISCUSSION: Participants have a positive view of the PEWS tool and perceive implementation of the PEWS to be a vital clinical decision support tool that could lead pediatric primary care providers to early detection of deteriorating children before the occurrence of an adverse event. Further study could determine the generalizability of implementing the PEWS in primary care.

Bakgrund: NEWS2 är en bedömningsskala som används för att identifiera tidiga tecken på en försämrad patient. Det har tidigare gjorts studier där patientsäkerheten har setts öka med hjälp av NEWS2. Det framkommer dock inte tydligt i tidigare forskning hur vårdpersonalen ställer sig till bedömningsskalan. Därför har vi valt att undersöka sjuksköterskans perspektiv på användningen av NEWS2.  Syfte: Att undersöka sjuksköterskans perspektiv på att använda bedömningsskalan NEWS2 på vårdavdelning.  Metod: En kvantitativ enkätstudie där urvalet bestod av 124 legitimerade sjuksköterskor från fem olika vårdavdelningar på länssjukhuset i Kalmar.  Resultat: Totalt 59 sjuksköterskor (svarsfrekvens 48%) besvarade enkäten. NEWS2 tillför trygghet i sjuksköterskans bedömning av patienten, som ett komplement till den kliniska blicken. Det finns en komplexitet i hur riktlinjerna för NEWS2 följs relaterat till de patienter som har ett högt NEWS2-värde i sitt habitualtillstånd. Det framkommer en signifikant skillnad i hur sjuksköterskor med längre yrkeserfarenhet (>10 år) mäter de vitala parametrar som ingår i NEWS2 jämfört med de som arbetat i mindre än 10 år.  Slutsats: NEWS2 bidrar till ökad patientsäkerhet ur ett sjuksköterskeperspektiv. Det finns dock förbättringspotential gällande hur sjuksköterskan använder sig av åtgärdsskalan i NEWS2. Riktlinjerna borde tydliggöras eller anpassas för att NEWS2 ska fungera optimalt på alla vårdavdelningar.

Volcano early warning systems are used globally to communicate volcano-related information to diverse stakeholders ranging from specific user groups to the general public, or both. Within the framework of a volcano early warning system, Volcano Alert Level (VAL) systems are commonly used as a simple communication tool to inform society about the status of activity at a specific volcano. Establishing a VAL system that is effective for multiple volcanoes can be challenging, given that each volcano has specific behavioural characteristics. New Zealand has a wide range of volcano types and geological settings, including rhyolitic calderas capable of very large eruptions (>500 km 3 ) and frequent unrest episodes, explosive andesitic stratovolcanoes, and effusive basaltic eruptions at both caldera and volcanic field settings. There is also a range in eruption frequency, requiring the VAL system to be used for both frequently active ‘open-vent’ volcanoes, and reawakening ‘closed-vent’ volcanoes. Furthermore, New Zealand’s volcanoes are situated in a variety of risk settings ranging from the Auckland Volcanic Field, which lies beneath a city of 1.4 million people; to Mt. Ruapehu, the location of popular ski fields that are occasionally impacted by ballistics and lahars, and produces tephra that falls in distant cities. These wide-ranging characteristics and their impact on society provide opportunities to learn from New Zealand’s experience with VAL systems, and the adoption of a standardised single VAL system for all of New Zealand’s volcanoes following a review in 2014. This chapter outlines the results of qualitative research conducted in 2010–2014 with key stakeholders and scientists, including from the volcano observatory at GNS Science, to ensure that the resulting standardised VAL system is an effective communication tool. A number of difficulties were faced in revising the VAL system so that it remains effective for all of the volcanic settings that exist in New Zealand. If warning products are standardised too much, end-user decision making and action can be limited when unusual situations occur, e.g., there may be loss of specific relevance in the alert message. Specific decision-making should be based on more specific parameters than the VAL alone, however wider VAL system standardisation can increase credibility, a known requirement for effective warning, by ensuring that warning sources are clear, trusted and widely understood. With a credible source, user groups are less likely to look for alternatives or confirmation, leading to faster action. Here we consider volcanic warnings within the wider concept of end-to-end multi-hazard early warning systems including detection, evaluation, notification, decision-making and action elements (based on Carsell et al. 2004).

In-ground slope monitoring is an essential part of landslide early warning systems. Precise movement data from borehole monitors can detect emerging hazards near critical infrastructure. Typically, monitoring is done with inclinometers, but lower-cost alternatives have emerged which have yet to be tested in Tennessee. Time domain reflectometry (TDR) records magnitudes and depths of movements along a buried coaxial cable. When paired with a remote data logger, TDR can wirelessly transmit high resolution movement data in real time, making it promising for landslide early warning systems. Tennessee Department of Transportation (TDOT) has proposed a one-year feasibility study to test TDR for use in unstable soil slopes near highways. The study area is a well-known landslide site along Interstate 40 in Roane County, TN. Careful siting of borehole instrumentation is crucial for accurate monitoring. The goal of this study is to optimize TDR installation, with three specific aims: (i) evaluate landslide morphology, (ii) pinpoint locations and depths with greatest movement, and (iii) assess spatiotemporal patterns across the site. Statistical analysis of prior data from 13 inclinometers showed ongoing slope movement over the 21-acre complex landslide. Spatial interpolation suggested an asymmetrical failure surface with both shallow and deep motion. Space-time cube analysis indicated varying movement rates and timing across the site, suggesting separate landslide bodies. Based on these results, three optimal borehole depths and locations were proposed for TDR instruments. This analysis will ensure accuracy in tests of TDR for early warning system feasibility in Tennessee.

Yes / Background The National Early Warning Score (NEWS) is being replaced with NEWS2 which adds 3 points for new confusion or delirium. We estimated the impact of adding delirium on the number of medium/high level alerts that are triggers to escalate care. Methods Analysis of emergency medical admissions in two acute hospitals (York Hospital (YH) and Northern Lincolnshire and Goole NHS Foundation Trust hospitals (NH)) in England. Twenty per cent were randomly assigned to have delirium. Results The number of emergency admissions (YH: 35584; NH: 35795), mortality (YH: 5.7%; NH: 5.5%), index NEWS (YH: 2.5; NH: 2.1) and numbers of NEWS recorded (YH: 879193; NH: 884072) were similar in each hospital. The mean number of patients with medium level alerts per day increased from 55.3 (NEWS) to 69.5 (NEWS2), a 25.7% increase in YH and 64.1 (NEWS) to 77.4 (NEWS2), a 20.7% increase in NH. The mean number of patients with high level alerts per day increased from 27.3 (NEWS) to 34.4 (NEWS2), a 26.0% increase in YH and 29.9 (NEWS) to 37.7 (NEWS2), a 26.1% increase in NH. Conclusions The addition of delirium in NEWS2 will have a substantial increase in medium and high level alerts in hospitalised emergency medical patients. Rigorous evaluation of NEWS2 is required before widespread implementation because the extent to which staff can cope with this increase without adverse consequences remains unknown.

No description available.

Failure to rescue (FTR) outcomes may be one consequence of the relationship be-tween healthcare provider behaviors and attitudes, organizational factors, and environ-mental factors that intersect to potentially threaten patient safety. Early warning systems (EWS) were designed as surveillance systems to reduce failure to rescue events and avoid morbidity and mortality. Challenges with EWS include lack of standardization, organiza-tional barriers, such as culture and supports, and human factor attributes such as intuition, expertise, and experience. The experience and perceptions of nurses using EWS technolo-gy as it relates to their clinical assessment, critical thinking, and decision-making skills has yet to be undertaken. This study adds to the body of EWS and FTR literature and the broader culture of safety literature in acute care environments. The purposes of this exploratory qualitative descriptive study was to explore the experiences of nurses using EWS in acute care practice settings and how they perceive it impacts on their critical thinking and clinical decision-making processes. The study identi-fied three informative findings: a) EWS has added value particularly with novice nurses or nurses new to practice settings, b) EWS provides benefits to nurses working in acute clinical environments that experience high volumes and high acuity of patients by alerting or reminding them about potential FTR situations, and c) Existing EWS may require mod-ification to improve adequacy, reduce redundancy, and reduce alarm fatigue. Based on the evidence reviewed, a qualitative study to increase our understanding of the experi-ence of nurses and their perception of the impact of EWS and related technology on their critical thinking and other nursing practice processes has the potential to contribute to a wider evaluation of EWS systems and to improve patient outcomes. / Thesis / Master of Science (MSc) / Before patients on general medical or surgical hospital units become so ill that they need to be transferred to an intensive care unit, they have abnormal vital signs and other physiological changes that can go unnoticed for 2448 hours. As these changes can be hard to detect and serious illness can begin very slowly at first, early warning systems have been developed to help health care professionals respond to patient’s conditions before they need to be in an intensive care unit. These early warning systems can be in the form of new technology and assist nurses with preventing a serious illness from becoming critical. It is not well research or understood how nurses experience such early warning systems technology and it is not well understood how nurses think this technology impacts their nursing practice. The overall aim of the study is to learn more about the experience and perception of nurses who use this technology, how they believe it informs their nursing practice and how it supports them in making clinical decisions about patient care.

Risk indicators are metrics that are widely used in risk management to indicate how risky an activity is. Among different types of risk indicators, early warning systems are designed to help decision makers predict and be prepared for catastrophic events. Especially, in complex systems where outcomes are often difficult to predict, early warnings can help decision makers manage possible risks and take a proactive approach. Early prediction of catastrophic events and outcomes are at the heart of risk management, and help decision makers take appropriate actions in order to mitigate possible effects of such events. For example, physicians would like to prevent any adverse events for their patients and like to use all pieces of information that help accurate early diagnosis and interventions. In this research, first we study risk assessment for occupational injuries using accident severity grade as an early warning indicator. We develop a new severity scoring system which considers multiple injury severity factors, and can be used as a part of a novel three-dimensional risk assessment matrix which includes an incident's severity, frequency, and preventability. Then we study the predictability of health outcome based on early risk indicators. A systems model of patient health outcomes and hospital length of stay is presented based on initial health risk and physician assessment of risk. The model elaborates on the interdependent effects of hospital service and a physician's subjective risk assessment on length of stay and mortality. Finally, we extend our research to study the predictive power of early warning systems and prognostic risk indicators in predicting different outcomes in health such as mortality, disease diagnosis, adverse outcomes, care intensity, and survival. This study provides a theoretical framework on why risk indicators can or cannot predict healthcare outcomes, and how better predictors can be designed. Overall, these three essays shed light on complexities of risk assessments, especially in health domain, and in the contexts where individuals continuously observe and react to the risk indicators. Furthermore, our multi-method research approach provides new insights into improving the design and use of the risk measures. / Ph. D.

Abstract The aim of the studie was to investigate if the Pediatric Early Warning Score system, PEWS, is an useful instrument on a children's inpatient ward, regarding the detecting of deterioration in children's vital signs. For this, a quantitative descriptive design with qualitative elements was used. Method: Study specific questionnaires were distributed to 86 persons (helpnurses, nurses and doctors). Of these, 36 answered and sent back the surveys. Results: Of 36 responses 25 felt experienced a faster detection of deterioration of vital signs in the child. Many felt that they had faster response from the physician on call by providing an assessment figure of the child's condition. Conclusion: Most of the persons experienced that the use of the assessment intrument PEWS detected a deterioration of the child´s vital signs earlier than before using the instrument. Staff experienced greater security in their work when they had a tool to help and they also experienced an earlier response from physicians. / SAMMANFATTNING   Syftet med studien var att undersöka om bedömningsinstrumentet Pediatric Early Warning Score, PEWS, är till användning och vägledning på barnavdelning med avseende att upptäcka försämring av barns vitalparametrar. För detta användes en beskrivande kvantitativ design med kvalitativa inslag. Metod: Ett studiespecifikt enkätformulär gick ut till 86 personer (undersköterskor, sjuksköterskor och läkare på två pediatriska vårdavdelningar). Av dessa besvarades 36 enkäter. Resultat: Av 36 svarande ansåg 25 att man snabbare upptäckte försämring av vitalparametrarna hos barnet. Många ansåg att de fick snabbare gensvar från jourläkare genom att uppge en bedömningssiffra över barnets hälsotillstånd. Slutsats: Med hjälp av bedömningsinstrumentet PEWS upplevde personalen att en upptäckt av försämring av barnets vitalparametrar gjordes tidigare, samt att gensvar från jourläkare erhölls snabbare. Personalen upplevde en ökad trygghet i sitt arbete då man hade ett arbetsredskap till hjälp.

Bakgrund: Inom akutsjukvård är bedömning av patientens vitalparametrar, det vill säga andningsfrekvens, saturation, puls, blodtryck, kroppstemperatur och medvetandegrad, sjuksköterskans ansvar och därmed en viktig arbetsuppgift. Tidig identifiering av försämring i patientens tillstånd, har i tidigare studier visat sig bidra till både minskad morbiditet och mortalitet. Därmed är sjuksköterskors evidensbaserade och säkra bedömningar av största vikt för patientens säkerhet och välmående. Vilket i sin tur bidrar till upprätthållen patientsäkerhet. Syfte: Syftet med studien var att utforska och beskriva sjuksköterskors följsamhet till Early Warning Score (EWS) och de faktorer som påverkar följsamheten inom akutsjukvård. Metod: Studien genomfördes som en integrativ litteraturstudie. Resultatet baseras på 14 vetenskapliga artiklar som analyserats i enlighet med Whittemore och Knafls arbetsprocess. Resultat: Analysen av artiklarna resulterade i tre teman och åtta subteman om följsamheten till Early Warning Score och de faktorer som påverkade följsamheten. Sjuksköterskors följsamhet till Early Warning Score visade sig påverkas av användbarhet, teamarbete och patienten bakom instrumentet. Inom dessa teman presenterades; erfarenhet, medvetenhet, prioritering, kommunikation, bristande läkarrespons, individanpassade parametrar och EWS i förhållande till kliniskt omdöme. Slutsats: Studien visade att det finns flera olika faktorer som påverkade följsamheten till Early Warning Score. Sjuksköterskor använder inte alltid instrumentet trots att det visade sig vara en viktig del i identifiering av försämrade patienter och likaså för patientsäkerheten. Studien gav inga säkra förklaringar till detta men belyste flera faktorer som påverkade följsamheten, vilket innebär att fenomenet är i behov av att ytterligare studeras. / Bakgrund: I akutsjukvården är bedömning av patientens vitala parametrar, såsom andningsfrekvens, mättnad, hjärtfrekvens, blodtryck, kroppstemperatur och medvetandenivå, sjuksköterskans ansvar och därmed en viktig uppgift. Tidig identifiering av försämring av patientens tillstånd har i tidigare studier visat sig bidra till både minskad sjuklighet och mortalitet. Sjuksköterskornas evidensbaserade och tillförlitliga bedömningar är därför av yttersta vikt för patientens säkerhet och välbefinnande. Vilket i sin tur bidrar till en bibehållen patientsäkerhet. Sikta: Denna studie syftar till att utforska och beskriva sjuksköterskors efterlevnad av Early Warning Score (EWS) och de faktorer som påverkar efterlevnaden i akutvården. Metod: Studien genomfördes som en integrativ litteraturstudie. Resultaten baseras på 14 vetenskapliga artiklar analyserade i enlighet med Whittemores och Knafls arbetsprocess. Resultat: Analysen av artiklarna resulterade i tre teman och åtta delteman när det gäller efterlevnaden av poängen för tidig varning och faktorer som påverkade efterlevnaden. Sjuksköterskors bedömning av vitala parametrar visade sig påverkas av eller påverka EWS användbarhet, lagarbete och patienten bakom instrumentet. Bland dessa teman var; erfarenhet, medvetenhet, prioritering, kommunikation, brist på läkarrespons, individualiserade parametrar och EWS i förhållande till klinisk åsikt. Slutsats: Studien visade att det finns flera olika faktorer som påverkat efterlevnaden av Early Warning Score. Sjuksköterskorna använder inte alltid instrumentet, även om det visade sig vara en viktig del i att identifiera patienter med nedsatt sättning och även för patientsäkerheten. Studien gav inga definitiva förklaringar till detta, men lyfte fram flera faktorer som påverkat efterlevnaden, vilket innebär att fenomenet är i behov av ytterligare studier.