Date of Award

Spring 5-11-2022

Document Type

Doctor of Nursing Practice Final Manuscript

Degree Name

Doctor of Nursing Practice

Department

Nursing

First Advisor

Pedro Colio DNP, RN, FNP-C, ENP-C, CCRN

Second Advisor

Brian Tyson, MD

Abstract

Background: Coronavirus 2019 (COVID-19) presents with variable clinical manifestations from asymptomatic to life-threatening organ dysfunction. The National Early Warning Score, also known as NEWS, was initially developed to detect adult inpatient deterioration using existing physiological data and adverse clinical outcomes from 35,585 medical admissions. The NEWS guideline consists of six parameters: respiratory rate, pulse, oxygen saturation, temperature, systolic blood pressure, and level of consciousness.

Purpose: This project implemented NEWS guidelines to identify patients at high risk for deterioration with COVID-19.

Evidence-Based Interventions: The project included retrospective-prospective chart reviews for 100 patients diagnosed with COVID-19 from October 2020 to December 2020. The pre intervention data included an assessment of current practice among the clinic providers with a 1-question survey. The post intervention data with NEWS guidelines consisted of chart reviews for 100 patients from December 2021 to February 2022. Interventions in this project consist of primary care provider education on the NEWS guideline to detect clinical deterioration in acutely ill patients with a standardized approach.

Evaluation/Results: The pre intervention data group had 60 patients who met NEWS guideline criteria, with 51 having low scores. Nine patients met a high score of NEWS (≥ 7) with two Emergency Department (ED) referrals (22% referral rate). The post intervention group had 95 patients who met the NEWS guideline criteria with 82 having low scores; 13 patients met a high score of NEWS (≥ 7) with 13 ED referrals indicating a 100% referral rate. The project resulted in a 78% increase in ED referrals for patients meeting a high score criteria.

Implications: NEWS has the ability to serve as an adjunct in clinical decisions for COVID-19 infected patients in various clinical settings. The standardization of the NEWS guideline brings an opportunity for appropriate clinical intervention to change patient health outcomes.

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