title: Strengthening the afferent limb of rapid response systems: an educational intervention using web-based learning for early recognition and responding to deteriorating patients.
abstract: The timely recognition and response to patients with clinical deteriorations constitute the afferent limb failure of a rapid response system (RRS). This area is a persistent problem in acute healthcare settings worldwide. In this study, we evaluated the effect of an educational programme on improving the nurses' knowledge and performances in recognising and responding to clinical deterioration.
  
  
  
  The interactive web-based programme addressed three areas: (1) early detection of changes in vital signs; (2) performance of nursing assessment and interventions using airway, breathing, circulation, disability and expose/examine and (3) reporting clinical deterioration using identity, situation, background, assessment and recommendation. Sixty-seven registered nurses participated in the randomised control study. The experimental group underwent a 3 h programme while the control group received no intervention. Pretests and post-tests, a mannequin-based assessment and a multiple-choice knowledge questionnaire were conducted. We evaluated the participants' performances in assessing, managing and reporting the deterioration of a patient using a validated performance tool.
  
  
  
  A significantly higher number of nurses from the experimental group than the control group monitored respiratory rates (48.2% vs 25%, p<0.05) and pulse rates (74.3% vs 37.5%, p<0.01) in the simulated environment, after the intervention. The post-test mean scores of the experimental group was significantly higher than the control group for knowledge (21.29 vs 18.28, p<0.001), performance in assessing and managing clinical deterioration (25.83 vs 19.50, p<0.001) and reporting clinical deterioration (12.83 vs 10.97, p<0.001).
  
  
  
  A web-based educational programme developed for hospital nurses to strengthen the afferent limb of the RRS significantly increased their knowledge and performances in assessing, managing and reporting clinical deterioration.
authors: Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
authors: Sok Ying
authors: SY
authors: Liaw
authors: Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
authors: Lai Fun
authors: LF
authors: Wong
authors: Department of Anesthesia, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
authors: Sophia Bee Leng
authors: SB
authors: Ang
authors: Department of Nursing, National University of Hospital, Singapore.
authors: Jasmine Tze Yin
authors: JT
authors: Ho
authors: Department of Anesthesia, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
authors: Chiang
authors: C
authors: Siau
authors: Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
authors: Emily Neo Kim
authors: EN
authors: Ang
mesh_terms: D000328:Adult; D000075902:Clinical Deterioration; D003194:Computer-Assisted Instruction; D004509:Education, Nursing, Continuing / Q000379:methods; D004521:Educational Measurement; D005260:Female; D057209:Hospital Rapid Response Team / Q000458:organization & administration / Q000592:standards; D006801:Humans; D008297:Male; D009738:Nursing Service, Hospital / Q000458:organization & administration / Q000592:standards; D055986:Vital Signs; D055815:Young Adult
keywords: Adverse events, epidemiology and detection; Continuing education, continuing professional development; Nurses; Simulation