Summary
JUST WORRY; Exploring triggers used by nurses to identify surgical patients at risk for clinical deterioration
Gooske Douw
AIM: The aim of this thesis is to explore nurses’ worry and its role in the process of early recognition of deteriorating surgical ward patients and reduction of unplanned Intensive Care (ICU) admissions and mortality.
METHOD: The Dutch-Early-Nurse-Worry-Indicator-Score (DENWIS) was developed based on literature review. During one year, nurses of three surgical wards prospectively scored the presence of worry and DENWIS-indicators and measured vital signs. The value of worry and DENWIS as predictors of unplanned ICU admissions or unexpected mortality with and without deviating vital signs was calculated.
FINDINGS: Worry with normal vital signs was expressed 605 times (3.2%), which resulted in 62 physician calls (10.2%) and more than half of calls resulted in justified interventions. The Area Under the Receiver Operating curve (AUROC) of worry, DENWIS and early warning score (EWS) to predict unplanned ICU/ HDU admissions or unexpected mortality were respectively 0.81, 0.85, 0.86. For DENWIS and EWS combined 0.91.
CONCLUSION: Nurses’ worry is an early indicator of deterioration and can be objectified. Worry and underlying signs combined in the DENWIS are good predictors of unplanned ICU admission or unexpected mortality and improve performance of an EWS. The DENWIS could contribute to clear and transparent communication during nurses’ shift handover, doctors’ rounds, or when calling for assistance.
Keywords: Nurses, worry, deterioration, Dutch-Early-Nurse-Worry-Indicator-Score, rapid response system
