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Inpatient Nursing Care and Early Warning Scores: A Workflow Mismatch

Watson, Anne PhD, RN; Skipper, Chantel MSN, RN, CPNP-AC; Steury, Rachel MSN, RN, C-NP; Walsh, Heather MSN, RN, PCNS-BC; Levin, Amanda MD

doi: 10.1097/NCQ.0000000000000058

Early warning scores calculated by registered nurses (RNs) are used in hospitals to enhance the recognition of and communication about patient deterioration. This study evaluated workflow variables surrounding calculation and documentation of one pediatric hospital's use of an early warning score. Results indicated that there were significant delays in documentation of early warning scores by RNs and inconsistencies between the early warning scores and vital signs collected and documented by non-RN personnel. These findings reflected information obtained from the RNs about how they prioritize tasks and use work-arounds to specific systems issues regarding assessment and documentation in the electronic medical record.

Supplemental Digital Content is Available in the Text.

Department of Critical Care Medicine (Drs Watson and Levin), Neuroscience and Surgical Nursing (Ms Skipper), Children's National Heart Institute (Ms Steury), and Board of Visitors Simulation Program (Ms Walsh), Children's National Medical Center, Washington, District of Columbia.

Correspondence: Anne Watson, PhD, RN, Department of Critical Care Medicine, Children's National Medical Center, Ste M4800, 111 Michigan Ave, NW, Washington, DC 20010 (

The authors thank Randall Burd, Craig Futterman, Pat Johnson, Michael Spaeder, and Savannah Sleicher.

The authors declare no conflict of interest.

Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal's Web site (

Accepted for publication: January 31, 2014

Published ahead of print: February 24, 2014

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins