title: Mandatory early warning scoring--implementation evaluated with a mixed-methods approach.
abstract: OBJECTIVE
  The aim of this study was to evaluate adherence to an intervention optimizing in-hospital monitoring practice, by introducing early warning scoring (EWS) of vital parameters.
  
  
  BACKGROUND
  Interventions comprising EWS systems reduce in-hospital mortality, but evaluation of adherence to such interventions is required to correctly interpret interventional outcome.
  
  
  METHODS
  Adherence was evaluated with a mixed-methods approach. Quantitative data, obtained pre-interventionally (2009) and postinterventionally (2010 and 2011), were used to calculate and compare time intervals between scorings of vital parameters. Semi-structured interviews were used to evaluate the implementation process.
  
  
  RESULTS
  We found significant reductions in time intervals between measurements of vital parameters in 2011 compared to 2009. Scorings of vital parameters were repeated within 8 hours in 71-77% of patients scoring total modified EWS levels of 0, 2 or 4. The theme Motivation by clinical relevance and meaningfulness was identified as crucial to the implementation process.
  
  
  CONCLUSIONS
  High adherence to an intervention may be strongly related to nurses' perceived clinical relevance of the intervention.
authors: Department of Anaesthesiology, Copenhagen University Hospital, Hvidovre, Denmark; Department of Clinical Sciences Malmö, Anaesthesiology and Intensive Care Medicine, Lund University, Skåne University Hospital, Malmö, Sweden. Electronic address: gitbunken@hotmail.com.
authors: Gitte
authors: G
authors: Bunkenborg
authors: Department of Neurorehabilitation, TBI Unit, Copenhagen University Hospital, Glostrup, Denmark. Electronic address: ingrid.poulsen@regionh.dk.
authors: Ingrid
authors: I
authors: Poulsen
authors: Department of Health Sciences, Lund University, and the Intensive Care Unit, Skåne University Hospital, Lund, Sweden. Electronic address: karin.samuelson@med.lu.se.
authors: Karin
authors: K
authors: Samuelson
authors: Clinical Science Centre, Copenhagen University Hospital, Hvidovre, Denmark. Electronic address: steen.ladelund.01@regionh.dk.
authors: Steen
authors: S
authors: Ladelund
authors: Department of Clinical Sciences Malmö, Anaesthesiology and Intensive Care Medicine, Lund University, Skåne University Hospital, Malmö, Sweden. Electronic address: jonas.akeson@med.lu.se.
authors: Jonas
authors: J
authors: Åkeson
mesh_terms: D024362:Advance Directive Adherence; D006801:Humans; D008991:Monitoring, Physiologic; D019095:Point-of-Care Systems; D055986:Vital Signs
keywords: Adherence; Early Warning Score; Implementation process; Monitoring practice; Vital parameters