Implementing an Educational Program for Nurses on Calling Emergency 1000 and Other Urgent Calls
By CHUNG Wai Yin, Kelley, RN, BSN, MN, Out Patient Department (OPD)
Out Patient Department (OPD) runs 24 hours a day. According to the guideline of the hospital, all Resident Medical Officers (RMO)s who work in OPD are responsible for all emergency calls in the hospital. Nurses play a key role in the chain of the in-hospital emergency response system1. In wards, nurses use Request for Escalation of Acute Care and Treatment (REACT) system to take actions for patients who are clinically at risk. RMO will be informed by calling OPD direct line (Ext. 8605) if the patient is in medium or high risk level. If the patient is in resuscitation level, an emergency call code: Emergency 1000 will be called and RMO will be sent to the ward with a staff from OPD, carrying a control key for elevator, an emergency box with extra equipment (include waveform capnography sensor) and Suxamethonium Chloride to the ward immediately. However, some inappropriate calls (30%) were received in May-July 2018. This impact the patients in OPD, staff in OPD, patients in other wards, passengers in the elevator and also a wastage of Suxamethonium Chloride. This may delay the patients who need resuscitation if there are inappropriate emergency calls.
Purpose and Problem Statement
The purpose of this project is to increase ward nurses’ knowledge and confidence on calling Emergency 1000 and other urgent calls by implementing an educational program. The PICO question is: Does implementing an educational program on calling Emergency 1000 and other urgent calls affect the ward nurses’ knowledge and confidence on informing RMO for urgent medical help?
Patient survival often depends on nurses’ decisions to call emergency assistance. An aim of the emergency system is to detect early recognition of signs of clinical deterioration and prompt intervention to prevent cardiac arrest. It is found that both physiologic triggers and the subjective (“worried”) criteria were important triggers for emergency team intervention.
There are 2 parts in this project. Both RN and EN ward nurses (n=18) from medical and surgical wards were recruited to participate in the assessment. Pre-intervention and post-intervention assessments contain 10 identical modified real cases scenario with 2 answer choices to evaluate the knowledge on calling Emergency 1000 and other urgent calls and self-rating questions on competency on activating emergency response system. An Educational program was conducted right after pre-intervention which is acting as a debriefing session after a resuscitation. Nurses can ask questions freely in small groups and share their experience.
The second part of the implementation is to modify the audit form on receiving urgent care calls and Emergency 1000. This is to record the number and reasons for the calls.
18 nurses were recruited from a medical ward and a surgical ward. The result shows that nurses’ knowledge increase 5% (from 92% correct to 97% correct) on calling Emergency 1000 and other urgent calls. Participants explained that in a calm and stress-free condition it is easy to make correct decision on activating emergency response system.
After the education program and sharing session, the self-rating questionnaire on competency increase 40% (from 15% to 55%) on understanding, competence and execution on calling Emergency 1000 and other urgent calls. In the educational program, nurses show that they are more confident on executing REACT system because those real cases scenario impact them. The Educational Program is informative and they tend to ask questions in small group with less hesitation.
In Aug-Sept, there are 100% (n=6) appropriate calls. However, there is no call from the medical ward and the surgical ward recruited in this project.
Recommendations and Next Steps
Real cases scenario sharing is an effective learning method for nurses. Nurses tend to ask questions with less hesitation in small groups. The time frame for this project is too short to capture data from some areas. There is no phone calls from any of these two wards.
The audit on Emergency 1000 and urgent calls is continued. Real cases scenarios are collected on appropriate and inappropriate calls for education in the future.