Implementasi Early Warning System (Ews) dalam Mendeteksi Perburukan Akut pada Pasien Dewasa di Ruang Rawat Inap Rumah Sakit
Abstract
The purpose of this scoping review is to identify how the application of EWS to detecting acute deterioration in adult patients in general ward hospital. The method used was a scoping review and the literature has been obtained from searches derived from four databases originating from PubMed, Scopus, Sage, and CINAHL. The results showed that the implementation of EWS consisted of 6 components (vital sign recording, EWS scoring and reading, EWS protocol, clinical response based on escalation protocol, information assistance process using bundle communication (SBAR), medical emergency team (MET) system activation). Seven main of vital sign have to measured are respiratory rate, oxygen saturation, oxygen supplementation, temperature, pulse, systolic blood pressure, and level of consciousness. Persistence and additional commitment since 2009 were identified as significantly increasing benefits during the implementation of EWS instruments to improve patient outcomes. This success was obtained from experience that can increase the knowledge and competence of nurses. Changes in the risk of the EWS score can be read by nurses as an indication of clinical deterioration that requires stabilization interventions. Innovations have also been carried out since 2013 which have been successfully implemented in various countries, especially in 2019 and 2021 which are called EWS electronic. Based on this study, EWS proved to be accurate in detecting deterioration in patients. Therefore, to improve the implementation of EWS nurses must have good knowledge, because in implementing EWS requires critical thinking, and the ability to analyze numerical score classifications as a basis for decision making.
Keywords: Early Warning System, EWS, Nurse Implementation, Patient deterioration.
References
Considine, J., Fry, M., Curtis, K., & Shaban, R. Z. (2021). Systems for Recognition and Response to Deteriorating Emergency Department Patients: A Scoping Review. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 29(1), 1–10. https://doi.org/10.1186/s13049-021-00882-6
Credland, N., Dyson, J., & Johnson, M. J. (2018). What Are the Patterns of Compliance with Early Warning Track and Trigger Tools: A Narrative Review. Applied Nursing Research, 44, 39-47. https://doi.org/10.1016/j.apnr.2018.09.002
Dalton, M., Harrison, J., Malin, A., & Leavey, C. (2018). Factors That Influence Nurses' Assessment of Patient Acuity and Response to Acute Deterioration. British Journal of Nursing, 27(4), 212-218. https://doi.org/0.12968/bjon.2018.27.4.212.
Eddahchouri, Y., Koeneman, M., Plokker, M., Brouwer, E., van de Belt, T. H., van Goor, H., & Bredie, S. J. (2021). Low Compliance to A Vital Sign Safety Protocol on General Hospital Wards: A Retrospective Cohort Study. International Journal of Nursing Studies, 115, 103849. https://doi.org/10.1016/j.ijnurstu.2020.103849
Gielen, A., Koekkoek, K., van der Steen, M., Martijn-Looijen, & van Zanten, A. R. H. (2021). Evaluation of The Initial General Ward Early Warning Score and ICU Admission, Hospital Length of Stay and Mortality. Western Journal of Emergency Medicine, 22(5), 1131–1138. https://doi.org/10.5811/WESTJEM.2021.6.50657
Kyriacos, U., Burger, D., & Jordan, S. (2019). Testing Effectiveness of the Revised Cape Town Modified Early Warning and SBAR Systems: A Pilot Pragmatic Parallel Group Randomised Controlled Trial. Trials, 20(1), 1–14. https://doi.org/10.1186/s13063-019-3916-0
Liaw, S. Y., Rashasegaran, A., Wong, L. F., Deneen, C. C., Cooper, S., Levett-Jones, T., Goh, H. S., & Ignacio, J. (2018). Development and Psychometric Testing of A Clinical Reasoning Evaluation Simulation Tool (CREST) for Assessing Nursing Students’ Abilities to Recognize and Respond to Clinical Deterioration. Nurse Education Today, 62(August 2017), 74–79. https://doi.org/10.1016/j.nedt.2017.12.009
Liu, V. X., Lu, Y., Carey, K. A., Gilbert, E. R., Afshar, M., Akel, M., Shah, N. S., Dolan, J., Winslow, C., Kipnis, P., Edelson, D. P., Escobar, G. J., & Churpek, M. M. (2020). Comparison of Early Warning Scoring Systems for Hospitalized Patients with and Without Infection at Risk For in-Hospital Mortality and Transfer to the Intensive Care Unit. JAMA Network Open, 3(5), e205191. https://doi.org/10.1001/jamanetworkopen.2020.5191
Mau, K. A., Fink, S., Hicks, B., Brookhouse, A., Flannery, A. M., & Siedlecki, S. L. (2019). Advanced Technology Leads to Earlier Intervention for Clinical Deterioration on Medical/Surgical Units. Applied Nursing Research, 49(July 2018), 1–4. https://doi.org/10.1016/j.apnr.2019.07.001
Mirawati, A., & Deswita, D. (2022). Efektivitas Early Warning System Score Dalam Pencegahan Perburukan Pasien Di Rumah Sakit. Jurnal Kesehatan Lentera' Aisyiyah, 5(1), 568-576. https://www.jurnal.politasumbar.ac.id/index.php/jl/article/view/125
Mullany, D. V., Ziegenfuss, M., Goleby, M. A., & Ward, H. E. (2016). Improved Hospital Mortality with A Low MET Dose: the Importance of A Modified Early Warning Score and Communication Tool. Anaesthesia and Intensive Care, 44(6), 734–741. https://doi.org/10.1177/0310057x1604400616
NCEC. (2020). Irish national early warning system (INEWS) V2 (previously NEWS): National clinical Guideline No. 1. An Roinn Salainte Department of Health. https://www.gov.ie/en/collecti on/c9fa9a-nati onal-clinical-guidelines/
NHS. (2018). Clinical guidelines on the use of early warning scoring system ( MEWS / NEWS2 ). 1–9. https://www.england.nhs.uk/ourwork/clinical-policy/sepsis/nationalearlywarningscore/
Pertiwi, D. R., Kosasih, C. E., & Nuraeni, A. (2020). Tinjauan Sistematis: Faktor-faktor yang Mempengaruhi Implementasi Early Warning Score (EWS) oleh Perawat di Rumah Sakit. Jurnal Kesehatan, 11(2), 124–132. https://doi.org/10.38165/jk.v11i2.223
Prihati, D. R., & Wirawati, M. K. (2019). Pengetahuan Perawat tentang Early Warning Score dalam Penilaian Dini Kegawatan Pasien Kritis. Jurnal Keperawatan, 11(4), 237–242. https://doi.org/10.32583/keperawatan.v11i4.531
Qolbi, N. Q. Y., Nursalam, & Ahsan. (2020). Knowledge and Skill in Relation to the Speed and Accuracy of the Nurses When Assessing Using An Early Warning System (EWS). Jurnal Ners, 15(2), 531–537. http://dx.doi.org/10.20473/jn.v15i2(si).20522
Royal College of Physicians. (2017). National early Warning Score (NEWS) 2: Standardising the Assessment of Acute-Illness Severity in the NHS. In Updated report of a working party (Vol. 17, Issue 6). RCP. https://www.rcplondon.ac.uk/projects/outputs/national-early-warning-score-news-2
Suhr, K., Steen, C., Albrecht-thompson, R., & Williams, J. (2020). NEWS Scoring System: Use in Hematologic Malignancies and Cellular Therapeutics Patient Population. CJON, 24(2), 21–28. https://doi.org/10.1188/20.CJON.E21-E27.
Triwijayanti, R., & Rahmania, A. (2022). Pengetahuan Perawat dalam Penerapan Early Warning System (EWS) di Ruang Rawat Inap. Jurnal Ilmu Keperawatan dan Kebidanan, 13(1), 12. https://doi.org/10.26751/jikk.v13i1.887
Trullen, J., Bos-Nehles, A., & Valvedre, M. (2020). From Intended to Actual and Beyond: A Cross-Disciplinary View of (Human Resorce Management) Implementation. International Journal of Management Reviews, 22, 150–176. https://doi.org/10.1111/ijmr.12220
Wigati, I., Arwani, A., & Dewi, M. C. (2020). Meningkatkan Keselamatan Pasien dalam Deteksi Dini Perburukan Kondisi Fisiologis Pasien Menggunakan National Early Warning Score (NEWS). Jurnal Kepemimpinan dan Manajemen Keperawatan, 3(2), 100-105. https://doi.org/10.32584/jkmk.v3i2.639
