References
Limitations of track and trigger systems and the National Early Warning Score. Part 3: cultural and behavioural factors
Abstract
This article discusses the evidence in relation to preventable deaths and a reported culture of suboptimal care. It warns of the dangers of over-relying on track and trigger systems (TTS) in place of clinical judgement. The article explores cultural and behavioural factors, the effects of short staffing and inappropriate skill mix, which all increase the risk of human error. It emphasises a key message that registered nurses must reflect on the need to change their individual and team approaches to the recognition and assessment of the deteriorating patient.
NHS Improvement (2016) suggested that 7% of reported deaths and severe harm incidents in acute hospitals for 2015 related to a ‘failure to recognise or act on deterioration’. This statistic highlights the fact that the challenges of recognising and responding to deteriorating patients remain an ongoing concern, despite the widespread use of track and trigger systems (TTS). Research by both Massey et al (2016) and McGaughey et al (2017) suggested that more research is needed to identify why logical TTS models do not always work in clinical practice. This article discusses the cultural and behavioural elements relating to compliance with using these models and their use in practice (Table 1).
As in any robust discussion, it is important to appraise the available evidence. A report from the National Audit Office (NAO) (2005), A Safer Place for Patients, indicated that there are 34 000 preventable deaths in acute NHS hospitals every year. The National Patient Safety Agency (NPSA) (2007) estimated that about 23 000 of in-hospital cardiac arrests were potentially avoidable. The National Confidential Enquiry into Patient Outcome and Death (NCEPOD) (2012) in its report, Time to Intervene, suggested that, with better care, 38% (413) of cardiac arrests could be avoided.
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