Title of the Change Project Student ID. MSc in Healthcare Management, Institute of Leadership, Royal College of Surgeons in Ireland Header line 1 Header line 2 Header line 3 Implementing the Healthcare Assistant National Early Warning Score (HCA-NEWS) in an Acute Hospital Roisin McLoughlin MSc in Leadership in Health Professions Education (Roisin.McLoughlin@hse.ie) Header line 1 Header line 2 Abstract This organisational development (OD) project centres on the implementation of the National Early Warning Score system for Healthcare Assistants (HCA-NEWS) in a medical directorate of an acute hospital. Recording and communicating a patient’s vital signs is a cornerstone of nursing practice. Routine patient observations are now delegated to HCAs working under the guidance of registered nurses (RN). The primary aim of the measurement of vital signs and the use of early warning scoring systems (EWS) is to enhance patient safety. The EWS is calculated as part of the overall vital signs assessment, and should be associated with appropriate and timely communication between the HCA and RN. The HSE Change model framework was used detailing the progression of the change project. A mixed methodology approach was utilised. Questionnaires were sent to HCAs who met the pre-requisites to attend the HCA-NEWS education programme. HCAs were supervised and supported by the RN to complete a period of supervised practice and skills assessment. HCAs undertook a self audit of EWS recordings. To standardise documentation and communication of EWS findings to the RN an ISBAR communication sticker was completed and placed in the nursing documentation. Focus group interviews were conducted with three groups; Clinical Nurse Managers, RNs and HCAs. An audit of documentation of NEWS observations was undertaken using Nursing Quality Care Metrics. Results from data collection methods were in congruence with the literature. The findings indicated increased communication between staff, increased confidence in caring, improved teamwork and further opportunities to provide direct patient care. However, the key challenge identified was around deployment of HCA staff that completed EWS training. Building strong collaborative relationships with key stakeholders resulted in motivation, ownership, partnership and commitment to the change. The project has been successfully implemented in the six medical departments of an acute hospital.

Header line 1 Header line 2 Methodology Evaluation Implementing the Healthcare Assistant National Early Warning Score (HCA-NEWS) in an Acute Hospital Roisin McLoughlin MSc in Leadership in Health Professions Education (Roisin.McLoughlin@hse.ie) Introduction & Background Methodology Evaluation The role of the HCA has developed to support the changing demands of healthcare. HCAs have an increased responsibility for direct patient care. They play a significant role in the detection and monitoring of acutely ill patients by undertaking routine clinical observations1 HCAs that meet national pre- requisites can attend an education programme and be assessed as competent by the RN to undertake NEWS The NEWS is a bedside track and trigger scoring system used by staff to calculate a total EWS from routinely collected observations. It aims to indicate early signs of deterioration in patients’ conditions and prompts more timely medical review and treatment of patients 2 The HCA must be trained and deemed competent to carry out this role safely as patient safety is of paramount importance . The HSE Change Model was used as a framework to facilitate the implementation of the HCA NEWS in clinical practice Step 1: Initiation Force field analysis Stakeholder analysis Step 2: Planning Engagement & collaboration with stakeholders Commitment & ‘buy in’ Step 3: Implementation HCA-NEWS Education programme Supervision & Competence Skills Assessment Self Audit of EWS Recordings Documentation & Reporting Step 4: Mainstreaming Evaluation Sustainability Results of a self audit of EWS recordings over a 2 month period highlighted patients vital signs are mostly recorded at night by the HCA Figure 1: HSE Change Model 3 Figure 3: Self Audit of EWS recordings Organisational Impact Aims & Objectives Improved Communication Improved Teamwork Increased Confidence in Caring Further opportunities for HCA to provide direct patient care To implement the NEWS for HCA’s in the medical directorate of an acute hospital The objectives of this project are to: Provide the National HCA-NEWS Education Programme Introduce the HCA-NEWS into clinical practice Establish a process to facilitate the HCA to safely perform NEWS Evaluate the impact of the HCA News in practice Evaluation The Logic Model was used in the overall evaluation of this project Kirkpatrick’s 4 Level model was used to evaluate the education programme 4 Figure 2: Evaluation of Education Programme References Conclusion Health Service Executive (2013) Facilitators Guide to Healthcare Assistants (HCAs) Measuring, Recording & Communicating Patients’ Vital Signs, incorporating the National Early Warning Score (Adult) using the National Patient Observation Chart. Dublin: HSE. Hogan J. (2006) Why don’t nurses monitor the respiratory rates of patients? British Journal of Nursing. 15(1), 489–91. Improving our services. A service users guide to managing change in the Health Service Executive.(2008) Kirkpatrick D (1996) Revisiting Kirkpatrick’s four-level model. Train Dev 1:54–59. By equipping the HCA with the relevant knowledge and skills to undertake HCA NEWS this will contribute to early recognition of the deteriorating patient and enhance patient safety