title: Use of a single parameter track and trigger chart and the perceived barriers and facilitators to escalation of a deteriorating ward patient: a mixed methods study.
abstract: OBJECTIVE
  To investigate nurses' use of a single parameter track and trigger chart to inform implementation of the National Early Warning Scoring tool. To report the characteristics of patients with triggers, the frequency of different triggers, and the time taken to repeat observations. To explore the barriers and facilitators perceived by nursing staff relating to patient monitoring.
  
  
  BACKGROUND
  Sub-optimal care of the deteriorating patient has been described for almost two decades. Organisations have responded by implementing strategies that improve monitoring and facilitate a timely response to patient deterioration. While these systems have been widely adopted the evidence-base to support their use is inconsistent.
  
  
  METHODS
  A mixed method service evaluation was carried out in an acute University hospital.
  
  
  METHODS
  Physiological triggers (n = 263) and characteristics of triggering patients (n = 74) were recorded from surgical and medical wards. Descriptive statistics were displayed. Questionnaires were distributed (n = 105) to student nurses, health care assistants and registered nurses. Themes and sub-themes were identified from content analysis.
  
  
  RESULTS
  Hypotension was the most frequent abnormality. There was variability in the time to repeat observations following a trigger. A high proportion of triggers were identified in older patients, as was a trend of longer time intervals between trigger and repeat observations. Nurses reported a number of barriers and facilitators to monitoring patients including: 'workload', 'equipment', 'interactions between staff' and 'interactions with patients'.
  
  
  CONCLUSIONS
  This study identified a number of barriers and facilitators to monitoring and escalation of abnormal vital signs, highlighting the complexity of the process and the need for a system-wide approach to a deteriorating patient.
  
  
  CONCLUSIONS
  The trend of longer delays following a trigger in older patients has not been identified previously and could reflect a knowledge gap of the physiological changes and response to acute illness in older people.
authors.affiliation: School of Health Sciences, City University London, London, UK.|Patient Emergency Response and Resuscitation Team (PERRT), University College London Hospitals, London, UK.
authors.forename: Duncan J
authors.initials: DJ
authors.lastname: Smith
authors.affiliation: School of Health Sciences, City University London, London, UK.|School of Nursing & Midwifery & NHMRC Centre of Research Excellence in Nursing (NCREN), Centre for Health Practice Innovation, Menzies Health Institute Queensland, Griffith University, Brisbane, Qld, Australia.|Intensive Care Unit, Princess Alexandra Hospital, Brisbane, Qld, Australia.
authors.forename: Leanne M
authors.initials: LM
authors.lastname: Aitken
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006323:Heart Arrest / Q000451:nursing*; D057209:Hospital Rapid Response Team / Q000592:standards; D006785:Hospitals, University; D006801:Humans; D008131:London; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000592:standards*; D009736:Nursing Process / Q000592:standards*; D017063:Outcome Assessment, Health Care; D013222:State Medicine; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: communication; critical care outreach; deteriorating ward patient; escalation; health care assistants; monitoring; national early warning score; older adults; patient safety; track and trigger charts