Serious adverse events and missed observations impact of limited resources of nurses based on national early warning score (NEWS)

Priyo Sasmito; Leli Mulyati; Fika Indah Prasetya; Janno Berty Bradly Bernadus; Sri Sumartini; Nisa Arifani; Yuyun Tafwidhah; Diana Ulfah

doi:10.33024/minh.v7i4.430

Authors

Priyo Sasmito Departemen Keperawatan, Fakultas Ilmu Kesehatan, Universitas Ichsan Satya
Leli Mulyati Poltekkes Kemenkes Bengkulu
Fika Indah Prasetya Prodi S1 Keperawatan, STIKes Bhakti Al-Qodiri
Janno Berty Bradly Bernadus Fakultas Kedokteran Universitas Sam Ratulangi
Sri Sumartini Departemen Keperawatan, Universitas Pendidikan Indonesia
Nisa Arifani Departemen Emergensi Medisin, Fakultas Kedokteran, Universitas Brawijaya, Malang
Yuyun Tafwidhah Prodi Keperawatan Universitas Tanjungpura
Diana Ulfah Prodi D3 Keperawatan Universitas Bhakti Kencana

DOI:

https://doi.org/10.33024/minh.v7i4.430

Keywords:

In-Hospital Mortality, Medical Wards, NEWS, Serious Adverse Events, Unplanned ICU Admission

Abstract

Background: Since become an obligation for hospital, Early Warning System (EWS) are widely used. National Early Warning Score (NEWS) is common EWS adopted in Indonesia. There are not many studies evaluating the implementation of the in hospitals with limited resources in Indonesia.

Purpose: To analyze the NEWS performance in the medical ward at one regional hospital in Serang District, Banten Province, Indonesia.

Method: Observational analytic study with retrospective approach using NEWS observation sheet of 163 medical adult patients. NEWS's performance was assessed by analyzing the amount of observation that was not carried out in the first 24 hours of hospitalization according to hospital safety protocols. The observed outcome was the occurrence of serious adverse events (SAE), unplanned Intensive Care Unit (ICU) admission, and in-hospital mortality. The data analyzed with Fisher Exact Test and Spearman Rho.

Results: Participants' age mean of 48.2 years old (range 17-85). Most were male (87/53.4%) with a NEWS score of 0 in the first 24 hours of hospitalization (91/55.8%). Of 72 (44.2%) missed observation patients, 8 (4.9%) experienced SAE, 5 (3.1%) transferred to the ICU, and 3 (1.8%) died in the ward. There are significant relationship (p-value 0.001) between missed observation and the occurrence of SAE and unplanned ICU admission (p-value 0.015). There is no relationship between missed observation and in-hospital mortality.

Conclusion: About forty percent of NEWS observation frequency in medical wards is still not under safety protocols that have been made by the hospital. Missed observation associated with SAE and unplanned ICU admission. Hospital stakeholders need to evaluate the implementation of NEWS in the hospital ward and take strategic action to increase its effectiveness.