PMID- 31888745
OWN - NLM
STAT- MEDLINE
DCOM- 20200921
LR  - 20200921
IS  - 1745-6215 (Electronic)
IS  - 1745-6215 (Linking)
VI  - 20
IP  - 1
DP  - 2019 Dec 30
TI  - Testing effectiveness of the revised Cape Town modified early warning and SBAR 
      systems: a pilot pragmatic parallel group randomised controlled trial.
PG  - 809
LID - 10.1186/s13063-019-3916-0 [doi]
LID - 809
AB  - BACKGROUND: Nurses' recognition of clinical deterioration is crucial for patient 
      survival. Evidence for the effectiveness of modified early warning scores (MEWS) 
      is derived from large observation studies in developed countries. METHODS: We 
      tested the effectiveness of the paper-based Cape Town (CT) MEWS vital signs 
      observation chart and situation-background-assessment-recommendation (SBAR) 
      communication guide. Outcomes were: proportion of appropriate responses to 
      deterioration, differences in recording of clinical parameters and serious 
      adverse events (SAEs) in intervention and control trial arms. Public teaching 
      hospitals for adult patients in Cape Town were randomised to implementation of 
      the CT MEWS/SBAR guide or usual care (observation chart without track-and-trigger 
      information) for 31 days on general medical and surgical wards. Nurses in 
      intervention wards received training, as they had no prior knowledge of early 
      warning systems. Identification and reporting of patient deterioration in 
      intervention and control wards were compared. In the intervention arm, 
      24 day-shift and 23 night-shift nurses received training. Clinical records were 
      reviewed retrospectively at trial end. Only records of patients who had given 
      signed consent were reviewed. RESULTS: We recruited two of six CT general 
      hospitals. We consented 363 patients and analysed 292 (80.4%) patient records 
      (n = 150, 51.4% intervention, n = 142, 48.6% control arm). Assistance was 
      summoned for fewer patients with abnormal vital signs in the intervention arm 
      (2/45, 4.4% versus (vs) 11/81, 13.6%, OR 0.29 (0.06-1.39)), particularly low 
      systolic blood pressure. There was a significant difference in recording between 
      trial arms for parameters listed on the MEWS chart but omitted from the standard 
      observations chart: oxygen saturation, level of consciousness, pallor/cyanosis, 
      pain, sweating, wound oozing, pedal pulses, glucose concentration, haemoglobin 
      concentration, and "looks unwell". SBAR was used twice. There was no 
      statistically significant difference in SAEs (5/150, 3.3% vs 3/143, 2.1% 
      P = 0.72, OR 1.61 (0.38-6.86)). CONCLUSIONS: The revised CT MEWS observations 
      chart improved recording of certain parameters, but did not improve nurses' 
      ability to identify early signs of clinical deterioration and to summon 
      assistance. Recruitment of only two hospitals and exclusion of patients too ill 
      to consent limits generalisation of results. Further work is needed on 
      educational preparation for the CT MEWS/SBAR and its impact on nurses' reporting 
      behaviour. TRIAL REGISTRATION: Pan African Clinical Trials Registry, 
      PACTR201406000838118. Registered on 2 June 2014, www.pactr.org.
FAU - Kyriacos, Una
AU  - Kyriacos U
AUID- ORCID: 0000-0003-1611-8014
AD  - Division of Nursing and Midwifery, Department of Health & Rehabilitation 
      Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South 
      Africa. una.kyriacos@uct.ac.za.
FAU - Burger, Debora
AU  - Burger D
AD  - Division of Nursing and Midwifery, Department of Health & Rehabilitation 
      Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South 
      Africa.
FAU - Jordan, Sue
AU  - Jordan S
AD  - School of Human and Health Sciences, Swansea University, Swansea, Wales, UK.
LA  - eng
GR  - Grant No. 90295/The South African National Research Foundation/
PT  - Journal Article
PT  - Pragmatic Clinical Trial
PT  - Randomized Controlled Trial
DEP - 20191230
PL  - England
TA  - Trials
JT  - Trials
JID - 101263253
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Cities/epidemiology
MH  - Clinical Decision-Making/methods
MH  - Early Diagnosis
MH  - *Early Warning Score
MH  - Female
MH  - Fever/*diagnosis/*epidemiology/nursing
MH  - Health Knowledge, Attitudes, Practice
MH  - Hospitals, Public
MH  - Hospitals, Teaching
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Monitoring, Physiologic/*methods/nursing
MH  - Nurses/psychology
MH  - Pilot Projects
MH  - Retrospective Studies
MH  - South Africa/epidemiology
MH  - *Vital Signs
MH  - Young Adult
PMC - PMC6937946
OTO - NOTNLM
OT  - Decision making
OT  - Early warning score
OT  - Healthcare systems
OT  - Nurse training (MESH terms: early diagnosis, monitoring - physiologic/nursing, 
      vital signs)
COIS- The authors declare that they have no competing interests.
EDAT- 2020/01/01 06:00
MHDA- 2020/09/22 06:00
PMCR- 2019/12/30
CRDT- 2020/01/01 06:00
PHST- 2019/02/04 00:00 [received]
PHST- 2019/11/18 00:00 [accepted]
PHST- 2020/01/01 06:00 [entrez]
PHST- 2020/01/01 06:00 [pubmed]
PHST- 2020/09/22 06:00 [medline]
PHST- 2019/12/30 00:00 [pmc-release]
AID - 10.1186/s13063-019-3916-0 [pii]
AID - 3916 [pii]
AID - 10.1186/s13063-019-3916-0 [doi]
PST - epublish
SO  - Trials. 2019 Dec 30;20(1):809. doi: 10.1186/s13063-019-3916-0.