Authors (including presenting author) :
Lee WM(1), Li HY(1), Mabel WSC(1),Yeung LM(2), Chan HK(2), Maisie K(1), Khair J(1), Soo MT(1), Jacqueline EL(1), Ronnie HLC(1)
Affiliation :
(1)Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital (2)Obstetric unit, Queen Mary Hospital
Introduction :
Neonatal Early Warning (NEW) Observation Chart was developed under the paediatric SAG (Specialty Advisory Group) workgroup on NEWS in early 2019. This NEW observation chart was modified from the Newborn Early Warning Trigger and Track (NEWTT) which was originally developed for use within newborn and maternity services across the United Kingdom (UK), by the British Association of Perinatal Medicine (BAPM), in 2015. Workgroup members were recommended to adopt this chart for use in their special care baby units. However, the use of a newborn early warning system in obstetric units has not been explored. In QMH, the initiative in adopting NEWTT and this NEW observation chart were brought forward to discussion with both neonatal team heads and obstetric nursing team at mid of 2019 and the feedback was positive. A modified NEWTT observation chart for use in labour ward (LW), postnatal (PN)ward and a modified NEW observation chart for use in SCBU of QMH were therefore developed respectively. The consensus in using the same action plan for triggering the escalation of observation frequency and review by doctor was reached.
Objectives :
- To integrate Neonatal Early Warning (NEW) system into nursing observation chart to guide nurses in early recognition and response to signs of deterioration in neonates -To standardize neonatal monitoring and observation frequency of vital signs in SCBU - To collaborate with obstetric team to standardize the early warning system and action plan on escalation of level of care for high risk neonates - To implement the NEW observation chart with action plan smoothly
Methodology :
1.)set up cross-departmental work group including nurses from neonatal unit, midwives from labour ward, postnatal ward and neonatal team heads 2.)develop cross-departmental guidelines on the Neonatal Early Warning observation 3.) re-design the neonatal observation charts which integrated a visual prompt to aid identification of abnormal parameter coding, namely, Red, Amber and white 4.)reach consensus in adopting the action plan for triggering the escalation of observation frequency and review by doctors through deliberation process 5.)Develop structural training plan for staffs 6.)roll out the observation charts in phases 7.)review the compliance regularly
Result & Outcome :
The neonatal observation chart integrated with early warning system was successfully implemented in both obstetric and special care baby unit since May of 2020. The same action plan for triggering the escalation of observation frequency and review by senior nurses or doctors was adopted and run smoothly.
