Modified Early Warning Score Effect in the ICU Patient Population

Transcription

1 Lehigh Valley Health Network LVHN Scholarly Works Patiet Care Services / Nursig Modified Early Warig Score Effect i the ICU Patiet Populatio Ae Rabert RN, DHA, CCRN, NE-BC Lehigh Valley Health Network, Ae.Rabert@lvh.org Follow this ad additioal works at: Part of the Nursig Commos Published I/Preseted At Rabert, A. (2013, October 29) Modified Early Warig Score Effect i the ICU Patiet Populatio. Preseted at Research Day 2015, Lehigh Valley Health Network, Alletow, PA. This Presetatio is brought to you for free ad ope access by LVHN Scholarly Works. It has bee accepted for iclusio i LVHN Scholarly Works by a authorized admiistrator. For more iformatio, please cotact LibraryServices@lvh.org.

2 Modified Early Warig Score Effect i the ICU Patiet Populatio Ae Rabert, RN, DHA, CCRN, NE-BC LVHN

3 Rapid Respose Teams (RRT) Team of credetialed health care providers who ca treat patiets wherever they are located Emergece occurred i the late 1990s based o the successful outcomes reported i Australia ad the Uited Kigdom Compositio ad fuctio of the team aligs with the orgaizatioal capabilities

4 RRT at LVHN Teams operatioal at the two largest acute care campuses Team composed of a critical care RN, respiratory therapist, ad hospitalist Program bega i 2007 Average calls per moth at the larger campus ad calls at the smaller campus

5 RRT Program Goal Primary goal of the RRT program is to reduce the umber of cardiac arrest outside of the ICU Program at LVHN has ot met this goal Why ad how could it?

6 Modified Early Warig Score (MEWS) Scorig system ratig physiologic parameters at desigated itervals Adjuctive strategy to RRT programs Proactive approach to care rather reactive approach of RRT Study its effect sice o prior use i the orgaizatio

7 MEWS Tool Score Heart Rate per Miute Systolic Blood Pressure Respiratory Rate per Miute Level of Cosciousess Temperature Less Greater 13 0 Less More 22 0 Uresposive Less Greater 30 Respods to pai Less 95.0 Respods to voice Alert Agitatio or cofusio New oset agitatio or cofusio Greater 101.4

8 MEWS Score Score Heart Rate per Miute Less Greater 130 Systolic Blood Pressure Respiratory Rate per Miute Level of Cosciousess Temperature Less More 220 Uresposive Less Greater 30 Respods to pai Less 95.0 Respods to voice Alert Agitatio or cofusio New oset agitatio or cofusio Greater 101.4

9 MEWS Score Score Heart Rate per Miute Less Greater 130 Systolic Blood Pressure Respiratory Rate per Miute Level of Cosciousess Temperature Less More 220 Uresposive Less Greater 30 Respods to pai Less 95.0 Respods to voice Alert Agitatio or cofusio New oset agitatio or cofusio Greater 101.4

10 MEWS Score Score Heart Rate per Miute Less Greater 130 Systolic Blood Pressure Respiratory Rate per Miute Level of Cosciousess Temperature Less More 220 Uresposive Less Greater 30 Respods to pai Less 95.0 Respods to voice Alert Agitatio or cofusio New oset agitatio or cofusio Greater 101.4

11 MEWS Score Score Heart Rate per Miute Less Greater 130 Systolic Blood Pressure Respiratory Rate per Miute Level of Cosciousess Temperature Less More 220 Uresposive Less Greater 30 Respods to pai Less 95.0 Respods to voice Alert Agitatio or cofusio New oset agitatio or cofusio Greater 101.4

12 MEWS Score Score Heart Rate per Miute Less Greater 130 Systolic Blood Pressure Respiratory Rate per Miute Level of Cosciousess Temperature Less More 220 Uresposive Less Greater 30 Respods to pai Less 95.0 Respods to voice Alert Agitatio or cofusio New oset agitatio or cofusio Greater 101.4

13 Research Study Desig Quatitative Study Retrospective medical record review Case-Cotrol Desig Cases possess the disease or evet to be studied Cotrols do ot Hypothesis tested at the 0.05 level of sigificace

14 Research Questios Research Questio 1: What differeces exist betwee case ad cotrol group subjects exhibitig a MEWS score of 5 or greater at least oce i the first 24 hours of a ICU stay? Research Questio 2: What deleterious chages i respiratory rate occur withi eight hours prior to a cardiac arrest evet?

15 Target Populatio Iclusio Criteria Patiets over 18 years of age Patiets admitted to the MICU/SICU betwee Jue 1, 2011 ad December 31, 2012 Cardiac arrest evet (case group oly) Exclusio Criteria Patiets uder the age of 18 Patiets trasferred to the MICU/SICU from aother level oe ICU o the campus Patiets admitted to the MICU/SICU with comfort care orders

16 Target Populatio Formulatio Target populatio icluded 2,792 patiets 4 patiets excluded because they were uder 18 Case group = 45 patiets experiecig a cardiac arrest evet Cotrol group = purposive coveiece samplig of the remaiig 2,743 patiets resulted i idetificatio of 45 subjects matched by age ad geder to those i the case group.

17 Data Collectio Data collectio required verbatim data extractio from 2 electroic health record systems used at the study orgaizatio MEWS score geeratio occurred after the completio of all data collectio Small pilot sample of 10 subjects i case ad cotrol groups occurred to verify accuracy of MEWS score values Cotiued data collectio occurred with remaiig group members

18 Sample Demographics Cases Cotrols Legth of Stay 5.6 days 3.26 days Admissio Source Emergecy Departmet Emergecy Departmet Admittig Service Medical ICU Medical ICU Admittig Reaso Respiratory Failure Post operative moitorig

19 RQ 1 Statistical Aalysis Coductio of McNemar s test usig bivariate statistics Assessed for presece of sigificat differece i patiets with at least oe MEWS score of 5 or greater betwee the case ad cotrol groups Hypothesis testig required sample subject categorizatio ito two dichotomous groups of all MEWS scores less 5 or at least oe score of 5 or greater

20 RQ 1 Statistical Aalysis MEWS Score > 5 at least oce Group 1 = Yes Group 2 = No Sample Case Group Highest Score Average Number of times score > 5 3 Not Applicable Cotrol Group Highest Score Average Number of times score > 5 2 Not Applicable

21 RQ 1 Statistical Aalysis McNemar s Test Results 30 cases had at least 1 MEWS score of > 5 i the first 24 hours of a ICU stay 13 had matchig cotrols with at least 1 score 17 had umatched cotrols 15 cases did ot have ay MEWS score of >5 9 had matched cotrols without ay score > 5 6 had umatched cotrols

22 RQ 1 Coclusios Statistically sigificat results (0.035) at the 0.05 level i a uique patiet populatio Null hypothesis rejectio; support of the alterative hypothesis idicatig a differece existed betwee cases a cotrols with at least 1 MEWS score of > 5 Research Implicatios iclude: Create stadard commuicatio used with cogitive cotiuum theory MEWS score of 5 or greater at least oe time i the first 24 hours of a ICU stay is a cardiac arrest evet predictor

23 RQ 2 Statistical Aalysis Use of Wilcoxo siged-rak test to determie differece betwee respiratory scores Score 1 = immediately before cardiac arrest Score 2 = four hours before cardiac arrest Score 3 = eight hours before cardiac arrest Each case subject required three Wilcoxo siged rak tests Score 2:1; Score 3:1; ad Score 3:2

24 RQ 2 Statistical Aalysis MEWS Respiratory Scores Case Group Oly (=45) Score 1 (Immediately before Cardiac Arrest) Score 2 (4 hours before Cardiac Arrest) Score 3 (8 hours before Cardiac Arrest) Number of Cases with Score Score Rage Mea Score Stadard Deviatio Media Score Mode Score 0 2 0

25 RQ 2 Statistical Aalysis Wilcoxo Siged-Rak Test Statistics Score 2:Score 1 Score 3:Score 1 Score 3:Score 2 Z score Sigificace

26 RQ 2 Coclusios Null hypothesis rejectio; support of the alterative hypothesis Cotributed to the curret literature i a uique patiet populatio Research implicatios iclude: Narrowig of eight hour pre-cardiac arrest widow for chages to those occurrig betwee four ad eight hours prior to a evet

27 Study Limitatios Sigle ceter study Case-cotrol desig MEWS tool Selectio ad value selectio Sesitivity ad specificity

28 Recommedatios Future Use MEWS tool use across all ipatiet uits i the study orgaizatio Total Score Respiratory parameter score Electroic calculatio Treatmet algorithms based o score values Future Study No-ICU patiets i the study orgaizatio Varied MEWS score values for future study Tool modificatio Icorporatio ito ew electroic medical record system Adjuct treatmet modality with curret RRT practices

29 Summary Study revealed sigificat outcomes of MEWS score beefit as a cardiac arrest predictor i a uique populatio. Also revealed sigificat chages i respiratory status occurred betwee four ad eight hours prior to a cardiac arrest evet Nursig research drivig ursig practice chages

30 Questios