Nursing Assignment: Barriers to Clinical Monitoring and EWS

This nursing assignment examines the critical issue of clinical deterioration in patients, emphasizing the significance of early detection of adverse events to improve patient safety and reduce mortality. The essay explores how close monitoring of physiological changes, particularly through the use of observation charts and vital sign analysis, can help in identifying and responding to deteriorating conditions. It also delves into the barriers that hinder effective clinical monitoring, such as communication gaps, inexperienced staff, and staffing shortages. The assignment highlights the role of Early Warning Systems (EWS) in hospitals, detailing their use of scoring systems based on vital signs to alert medical teams to critical conditions. The essay concludes by underscoring the impact of effective communication, staff training, and adequate staffing in optimizing the use of EWS and reducing preventable deaths and patient deterioration cases.

Running head: NURSING ASSIGNMENT
Nursing assignment
Name of the Student
Name of the University
Author Note

1NURSING ASSIGNMENT
Clinical deterioration of patients can occur at any time point during their illness or
when they are under the care process. Patients generally become more vulnerable to
deteriorating symptoms upon hospital admission, post-surgery or while recovering from
a chronic disorder (Escobar et al., 2012). The essay will illustrate how close monitoring
of the physiological changes can help in avoiding serious adverse events and reducing
mortality. It will further elaborate the different barriers to such clinical monitoring.
Early detection of deteriorating signs in a patient is essential to improve patient
safety and the response to adverse events. Failure to closely monitor the early signs
leads to increased mortality and morbidity. Around 70% patients suffering from cardiac
arrest show respiratory trouble 8 hours before the episode. Responding to early
detection helps to reduce mortality and associated healthcare costs.
An observation chart is most essential in recording the vital signs of the patient
and collecting relevant information related to identifying his health status. Vital sign
detection assesses the severity of illness in the patient and connects them to timely
response (Preece et al., 2012). In case of patients with cardiopulmonary disorders,
timely management of beta blockers, emergency resuscitation and angiography have a
substantial impact in reducing mortality.
There are several barriers to early recognition of deterioration signs. The staff
often fails to adequately communicate among themselves regarding the patient’s
condition. This particularly occurs during transfers or handovers. Inexperienced staff
fails to understand the information handed over to them. Incomplete compilation of fluid
and observation charts lead to missing data and show discrepancies (Purling & King,

2NURSING ASSIGNMENT
2012). They fail to identify the trends of vital signs. Shortage of staff during weekends or
sick leaves makes it difficult for nurses to observe the deterioration signs.
In recent years, many hospitals have employed an Early warning system (EWS)
that assists in early detection of critical conditions. These systems employ
measurement of vital signs (Ludikhuize et al., 2012). Any deviation of the signs form the
normal ranges alerts the staff of the ward or critical care team to outreach the patient
and evaluate the deteriorating conditions. These systems utilize a calling criterion and
empower clinicians for more effective intervention.
During clinical placement, the importance of early warning systems was
elucidated. A scoring system was given that helped to measure vital signs. The EWS
scores for 6 physiological variables like respiratory rate, heart rate, oxygen saturation,
consciousness level, urine output and systolic blood pressure help to consistently
determine the degree of illness and enables medical team to work faster and deliver
adequate care (Smith et al., 2013). The utility of EWS across ambulance transportation
and primary care was also demonstrated.
Thus, it can be concluded that early warning scores play a significant role in
reducing the number of patient harm or deterioration in-hospital settings. Thorough
monitoring of the vital signs help to lower the hospitalization stays, health costs and
mortality. If communication, inexperience and shortage of staff barriers are removed,
early warning signs can effectively reduce the figures of avoidable deaths and patient
deterioration cases.

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References
Escobar, G. J., LaGuardia, J. C., Turk, B. J., Ragins, A., Kipnis, P., & Draper, D. (2012).
Early detection of impending physiologic deterioration among patients who are
not in intensive care: development of predictive models using data from an
automated electronic medical record. Journal of hospital medicine, 7(5), 388-395.
Ludikhuize, J., Smorenburg, S. M., de Rooij, S. E., & de Jonge, E. (2012). Identification
of deteriorating patients on general wards; measurement of vital parameters and
potential effectiveness of the Modified Early Warning Score. Journal of critical
care, 27(4), 424-e7.
Preece, M. H., Hill, A., Horswill, M. S., & Watson, M. O. (2012). Supporting the detection
of patient deterioration: observation chart design affects the recognition of
abnormal vital signs. Resuscitation, 83(9), 1111-1118.
Purling, A., & King, L. (2012). A literature review: graduate nurses' preparedness for
recognising and responding to the deteriorating patient. Journal of clinical
nursing, 21(23-24), 3451-3465.
Smith, G. B., Prytherch, D. R., Meredith, P., Schmidt, P. E., & Featherstone, P. I.
(2013). The ability of the National Early Warning Score (NEWS) to discriminate
patients at risk of early cardiac arrest, unanticipated intensive care unit
admission, and death. Resuscitation, 84(4), 465-470.