1. Title of the Change Project
Student ID.
MSc in Healthcare Management,
Institute of Leadership, Royal College of Surgeons in Ireland
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Implementing the Healthcare Assistant National Early Warning Score
(HCA-NEWS) in an Acute Hospital
Roisin McLoughlin
MSc in Leadership in Health Professions Education
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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.

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Implementing the Healthcare Assistant National Early Warning Score
(HCA-NEWS) in an Acute Hospital
Roisin McLoughlin
MSc in Leadership in Health Professions Education
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