The Early Warning System (EWS) is a detection system used to spot changes in a patient’s worsening condition(Peate, 2014). The EWS has proven to be a beneficial system for detecting patients who are at risk of deterioration in clinical conditions up to the point of death(Peate, 2014). This system aims to assist the clinical staff when identifying the early danger signs of critical patients while in the inpatient room before there is a decline in the widespread clinical conditions This is done to prevent unwanted events will also encourage the provision of action as early as possible with the aim of improving patient outcomes. Errors when filling in or interpreting the results of the EWS assessment causes a delay and inaccuracy in the clinical response. This will worsen the patient’s condition, which can increase the mortality rate of the patients in the inpatient room.
Preliminary data from 20 nurses about the implementation of the EWS in an Internal Medicine Inpatient Installation Hospital in Malang explained that 75% (15 people) had difficulty applying the EWS, 50% (10 people) made errors when completing the EWS instruments, 50% (10 people) made errors when interpreting the EWS instruments, 100% (20 people) had never received the necessary EWS training, but they had received information about the EWS. Besides, 80% (16 people) said that the observation sheets were not practical because they had to read their interpretations on different sheets. Several previous studies have attempted to uncover the nurses’ knowledge of the EWS assessment Errors when conducting the EWS assessment can be prevented by requiring every health worker to attend education, training, and demonstrations on the implementation of an EWS in the hospital. Timeliness and competence when conducting EWS assessments can improve patient safety. Delay and inaccuracy in an assessment using the EWS will result in a worsening of the patient’s condition which pairs with an increase in the mortality risk in the inpatient room.
The EWS has been widely applied by several hospitals in Indonesia, notably since the Hospital Accreditation Commission in Indonesia (KARs) established the EWS in the National Accreditation Standard known as the SNARS Edition 1 in 2017. An explanation of the EWS is listed in the Patient-Focused Service Standards: Chapter 4 Patient Services and Care (PAP) 3.1 about Detection (Recognizing) Changes in Patient Condition. The EWS system allocates points in a weighted manner based on the derangement of a predetermined set of vital signs from an arbitrarily agreed “normal” range. The early warning scoring system (EWSS) was introduced by Morgan et al. in 1997 as a simple tool that can be applied by the ward staff to identify patients developing a critical illness. In 2012, the Royal College of Physicians conducted an EWSS evaluation and standardization. It came to be known as the National Early Warning Score (NEWS).
NEWS is a systematic approach that uses scoring to identify changes in someone’s condition while determining the next step that must be done. A standardized NEWS has been introduced for use in the National Health Service (NHS) in the UK. The RCP recommended that an EWS assessment should be performed on adult patients (16 years or older) to assess an acute disease, to detect clinical decline, and to initiate timely and appropriate clinical responses. It is used as an aid for clinical judgment and not as a substitute for competent clinical judgment. It is also used for the initial assessment of acute illness and the ongoing monitoring of a patient’s condition during their stay in the hospital, for prehospital assessments where there is an acute patient condition conducted first responders such as the ambulance services, primary health services, and the public health center to optimize the communication of the patient condition before the destination hospital receives them. The determination of NEWS is based on six physiological parameters namely respiratory rate, oxygen saturation, temperature, systolic blood pressure, pulse rate and the level of consciousness
Author: Qolbi Nur Q.Y., Nursalam Nursalam, and Ahsan Ahsan
Informasi detail dari tulisan ini dapat dilihat pada: https://e-journal.unair.ac.id/JNERS/article/view/20522
