1. Dunscomb, Jennifer MSN, RN, CCRN

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The purpose of the inquiry was to design an early warning trigger system that would identify patients for rapid evaluation, diagnostic reasoning, and prompt planning/interventions to prevent failure to rescue events.



It is estimated that 70% of respiratory and cardiac arrest can be prevented through early recognition and planning. With the complexity and high demands of nurses, recognition of subtle physiological changes becomes difficult on a medical-surgical unit.



There are numerous scoring systems that help the nurse predict deterioration in the patients condition; however, these systems are implemented manually at the bedside. Other systems require retrospective review to obtain physiological predictions or expensive computerized technology for implementation. Thompson Healthcare-Mdata Care Focus is a customizable profiling engine which uses hospital-defined clinical data to identify specified patient populations within a handheld device.



The clinical nurse specialist (CNS) collaborated with information services to design a care focus program that used vital sign parameters from the Early Warning Scoring System, specific triggers from the Institute of Health Care Improvement Global Trigger Tool, Systemic Inflammatory Response Syndrome criteria, and physiology from Acute Physiologic and Chronic Health Evaluation. The care focus, Early Warning Trigger System, is used to highlight abnormal patient information and the combination of variables that together may contribute to adverse harm. The CNS reviews patients daily for potential complication with further evaluation and diagnostic reasoning. Plans are then quickly developed to initiate rapid treatment to mitigate potential complications. The application was tested, then disseminated to other nurses who partner with the CNS to ensure progression to the plan of care. The CNS provided knowledge transfers by collaboratively partnering with nurses to identify triggers and engage in clinical reasoning of real-time patient experiences.



After rapid testing of the clinical innovation, medical-surgical codes have reduced by 50% with an indirect decrease in hospital mortality.



Potential adverse complications were mitigated in multiple scenarios when the CNS designed and applied the early warning trigger system.


Implications for Practice:

The implication for nursing and advanced practice nursing is immense when enhancement of clinical reasoning, knowledge transfer, and improvement of patient outcomes can occur with the use of innovative technology.