Improving the Completeness and Accuracy of NEWS2 Observation Recording

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Background & Problem

Annual audit (acute inpatient wards) by ACRT evidenced poor compliance regarding the completeness and accuracy of NEWS2 observation recording (53%). This has implications for patient safety, particularly regarding the recognition of acute and deteriorating illness which is a precursor to escalation and management.

Aim

To improve completeness and accuracy of NEWS2 recording trust-wide to 80% by June 2019 using a PDSA approach to identify strategies that can be shared.

Method

Following construction of a driver diagram, selected change ideas were implemented trust-wide and impact studied.

1. Monthly trust-wide external audit with visual results reporting
2. Standardised training/resources
3. Monthly ‘league table’
4. Customised eLearning

Concurrently, following poor baseline results Avening Ward agreed to act as a pilot, whereby the ward team overseen by their senior NEWS2 link nurse identified their own approaches and change ideas for improvement, the impact of which were studied. Lessons could be learnt from this small scale approach to change with opportunity for scale up and spread.

Results

80% compliance trust-wide for completeness and accuracy of NEWS2 observation recording was not achieved. Nonetheless, change ideas motivated staff, raised the importance and profile of NEWS2 recording and resulted in improvement:

• Completeness of observation recording increased from 64% to 78%
• Accuracy of observation recording improved from 53% to 64%
• The frequency count of missed parameters reduced from 106 to 39
• ‘Pareto analysis’ identifies the most influential missed parameters are ACVPU, Respirations, Temperature and Heart Rate.

Pilot ward results:

Individual wards ‘year to date trends’ show natural variance, which is amplified by the random snapshot audit methodology used. Wards evidencing less variation e.g. ‘Avening’ show that success is derived from good clinical leadership, ownership and the utilisation of multiple change strategies.

Simulation Education proved particularly beneficial, raising the profile and importance of accurate NEWS2 observation recording, and increasing knowledge skills and confidence in managing acutely ill and deteriorating patients.