Marjon Borgert

30 Chapter 2 Compliance with protocol and degree of implementation Compliance with the MEWS and RRS protocol is described in Table 2. Nurses calculated a MEWS in 70% (2513/3585) of the measurements on protocol wards and in 2% (65/3013) on control wards. Compliance of vital sign measurements three times per day on the protocol wards was achieved in 68% (819/1205). The median number of measurements per day was 3 (IQR 2-3) on protocol wards and 2 (IQR 1-2) on control wards. On control wards, retrospective review of vital signs indicated abnormal observations warranting the need for calculation of a MEWS according to the protocol in 41% (1232/2977) of all measurements. In only 4% (47/1232) of the measurements, the score was actually determined. AcriticalMEWSwas recordedbynurses in9%(338/3585) ontheprotocolized versus 1% (35/3013) on the control wards. Comparing the actually documented MEWS with the retrospective MEWS calculations, a critical MEWS was identi ed in 11% (381/3585) on the protocolized versus 7% (217/3013) on the control wards indicating the presence of calculation errors. In 43% (1552/3585) of measurements on protocol wards, the complete set of vital signs including MEWS was measured compared to 1% (31/3013) on control wards. In the majority of the measurements taken on control wards, the ‘routine’ set consisted of temperature, blood pressure, and heart rate. A ‘perfect’ measurement of all vital signs, including MEWS without calculation errors, was present in 14% (483/3585) of protocolized measurements versus 0.3% (8/3013) of control measurements. Delay in noti cation of the physician The presence of delaywas analyzed in 99 patients (Table 3). In 49% (28/57) of the patients in the protocol arm and 50% (2/4) in the control arm, delays were present in identifying deterioration. When critical MEWS were measured by nurses on protocolized wards, a delay of 20 hours (IQR 5.5-54.0) was observed between the rst registered critical MEWS and the noti cation of the physician, versus 44 hours on control wards, ( P =0.79). When analyzing the delay using the retrospectively calculated critical MEWS, the presence of delay was 16.5 hours (IQR 6.0-40.5) on protocolized wards versus 23.5 hours (IQR 23.5- 23.5) on control wards, ( P =0.79).