Sample: National Early Warning
Score and associated Education
Programme Project Plan
Version
Modifications
0.1
Draft
Initial Draft
0.2
Draft
Modifications to initial
draft
Adapted with kind
permission of
Beaumont Hospital
Updated 23rd May 2012
Author
Date
Objectives
√
• Agreement in principle to the Project
Initiation
Document (PID)
√
• Direction & guidance on some
key decisions
relating to project scope
• Medical leadership to be identified
√
• Highlight significant service implications
associated with NEWS project
rollout
√
• Identification of pilot
wards/units/departments
Table of Contents
1. Introduction
Purpose of the document
Project Context
2. National NEWS Framework
NEWS Framework Objectives
Key Components of NEWS Project
NEWS project scope
Project Phasing
3. Project Management
NEWS project structure
Project roles & responsibilities
Project Assumptions
4. Project Workstreams
Work streams overview
NEWS policy & Observation chart
Emergency Response System /MET Team Development & Escalation protocol
Education -COMPASS, ViEWS and ISBAR Communication tool
Evaluation & Audit
5. Project Plan
Project Implementation Plan
6. Project Assumptions
7. Clinical Risk Assessment and KPI’s
Purpose of the document
•
The purpose of this document is to set out the terms of reference for a project to deliver the
Implementation of NEWS Project in ………………………Hospital through a Project Initiation Document (PID)
•
The document will also outline how the NEWS Project will be managed. The project organisation are also
detailed in this document.
•
The PID addresses the following fundamental aspects of the project:
– What the project is aiming to achieve
– Why it is important to meet the stated aims
– To provide a clear and unambiguous view of how the project will be managed and controlled
– Who will be involved in managing & delivering the project; their roles and responsibilities
– How and when the arrangements covered in this document will be put into place.
•
This document will be agreed and approved by the NEWS Steering Group as part of the project initiation
stage
•
The Project Manager (………………….) will be responsible for it’s maintenance throughout the project life
Project Context
The National Early Warning Score initiative is a work stream of the Acute Medicine Programme
in association with other Clinical Programmes, Quality & Patient Safety, Office of the Nursing
and Midwifery Services Director, Clinical Indemnity Scheme, the Assistant National Director,
Acute Hospital Services, Integrated Service Directorate, Irish Association of Directors of Nursing
and Midwifery (IADNAM) and the Therapy Professionals Committee.
•International literature identifies that 11% of hospital deaths can be attributed to patient
deterioration not recognized or acted upon.
•National Patient Safety Agency (2007) Patient deterioration not recognized in hospitalized patients.
•International literature identifies that 11% of hospital deaths can be attributed to patient
deterioration not recognized or acted upon.
•A large proportion of patients who suffer cardiac arrest in hospital have recognisable changes in
routine observations during the preceding 24hrs including changes in vital signs, level of
consciousness and oxygenation. One study showed that 60% of primary events investigated
(deaths, cardiac arrests and unplanned ICU admissions) were preceded by abnormal physiology.
(Hillman K.M. et al. “Antecedents to Hospital Deaths”. Intern Med J 2001; 31(6); 343-8)
•Early recognition of clinical deterioration, followed by prompt and effective action, can minimise
the occurrence of adverse events such as cardiac arrest, and may mean that a lower level of
intervention is required to stabilise a patient. (Smith GB et al, Resuscitation 2006; 71: 19-28)
Project Context
•
Early warning scores have been developed to facilitate early detection of deterioration by categorising a
patient’s severity of illness and prompting nursing, and other healthcare professionals, to request a
medical review at specific trigger points, utilising structured communication tools whilst following a
definitive escalation the occurrence of adverse events such as cardiac arrest, and may mean that a lower
level of intervention is required to stabilise a patient. plan.
•
Phase 1 of the National Early Warning Score initiative applies to Adult patients in Acute Hospital Services.
•
In April of 2011 HIQA recommended that the HSE should, as a priority, agree and implement a national
early warning score to ensure that there is a system of care in place for the prompt identification and
management of clinically deteriorating patients.
•
In July, 2011 the National Early Warning Score Governance Group launched the guiding framework and
policy for the national Early Warning Score System to recognise and respond to clinical deterioration. This
document was updated in January 2011, following a review of the programme, to take account of more
recent international research. The Australian Compass Programme (2010) has been selected as the
national tool for education on the deteriorating patient which now incorporates the VitalPACTM (ViEWS)
scoring parameters (Dec 2011).
On March 27th 2012 the National Clinical Programmes formally launched the
National Early Warning Score and associated COMPASS Education Programme.
HIQA Report 2012
The National Early Warning Score (NEWS) should be implemented in all clinical
areas providing inpatient care. An emergency department specific system of
physiological monitoring and triggered responses comparable to the NEWS
should be implemented.
HIQA Report 2012
‘It is not acceptable that an EWS was not in place given that the Authority had
previously recommended in the Report of the investigation into the quality and
safety of services and supporting arrangements provided by the Health
Services Executive at Mallow General Hospital (2010) that an EWS be
implemented in all hospitals in Ireland and that the HSE should ensure a
system-wide application and dissemination of this.
National Early Warning Score Framework Objectives
To improve patient safety and outcomes by :
• Supporting the implementation of the national standard for recognising
and responding to clinical deterioration -the ViEWS system and the
associated multidisciplinary educational programme – COMPASS in acute
healthcare settings
• Promoting more effective inter-professional communication and teamwork
by recommending the implementation of the structured communication
tool “ISBAR”
(Identification; Situation; Background; Assessment; Recommendation)
• Supporting the development and implementation of appropriate
organisational support systems for the early detection and escalation of
care of at risk patients
• Enabling audit of outcomes and performance comparison between
different healthcare facilities
Project Implementation Principles
• All clinical staff must comply with the national guiding framework and
related policies, clinical guidelines, procedures and protocols. Each
employee must adhere to their professional scope of practice guidelines
and maintain competency, in recognising and responding to patients with
clinical deterioration, including the use of the National Early Warning
Score System (ViEWS).
• All staff will be comprehensively trained and supported during the NEWS
implementation
• The operation of the NEWS will require MDT co-operation
• While aspects of the NEWS may be customised for use in …………………….
Hospital the ViEWS parameters and core objectives of the National
Programme will be maintained
• All policies, protocols, documents, forms etc, will be initially developed in
draft form, extensively consulted and formally approved by the
appropriate body before implementation
In Scope\Out of Scope
Patients (in scope)
• All adult in-patients & out patients requiring interventional procedures and
sedation
• All patients attending AMU/AMAU/MAU
• ED presentations identified as requiring NEWS at triage & all patients
identified for admission
• Any patient where professional judgement of staff identifies a need to carry
out an EWS because of concern re their condition
• Patients in a critical care environment (ITU, Recovery Room, CCU) EWS at
transfer to ward
Patients (out of scope)
• Palliative care (active end of life care) & routine OPD
• Not For Resus (NFR) Patients (documented in Patients Chart)
• Paediatrics, CNU
• Obstetric Patients
In Scope\Out of Scope (cont.)
Key tasks (in scope)
• Develop a Hospital wide NEWS Policy
• Develop and implement an Escalation plan & Emergency Response System /
Medical Emergency Team (MET) integrating with existing arrangements
• Review and design an observation chart incorporating (NEWS) for use in
…………………(name of service)
• Provision of education and training of all clinical staff measuring/interpreting
Vital Signs
• Implementation of the standard communication tool (ISBAR)
• Implementation of an Evaluation and Audit process
• Delivery of a comprehensive cross hospital communications plan
• Key tasks (out of scope)
• Education for undergraduate Nursing students year 1-3 and Medical students
Project Management Structure
•The Project Management Structure will comprise the following components:
–
Oversight (“Steering Group”)
–
Management & Execution - Project Manager and Work stream Leads to work on the
Individual work streams
–
The Work stream leads will establish their own work stream groups as required
–
Each work stream will have a Working Group to support it in its work. The composition of
the Working Group will be agreed by the Work stream Lead in conjunction with the Project
Manager. It is possible that some Working Groups may provide support to more than one
work stream or that individuals may be on more than one Working Group
•The structure and the Roles and Responsibilities are outlined in the following slide
•The Steering Group will meet every 6-8 weeks during phase 1 of the project:
–
On the first occasion to approve the Project Initiation Document (including objectives,
timelines, etc)
–
On subsequent occasions to get a project progress reports & authorise key stages/
decisions of the project
•The Project Team will meet on a fortnightly basis
•Work stream and Working Group meetings will occur as required by the Work stream lead
Project Roles & Responsibilities
Steering Group
•
•
•
•
•
•
•
•
•
Ensure the project is
established and appropriately
managed
Provide overall direction and
leadership for the delivery and
implementation of the project
Ensure that the project is
aligned with Hospital & HSE
Strategic objectives
Ensure that the project
Manager and Work stream
Leads have the staff and other
resources to deliver the
project
Resolve any issues that are
escalated from the project
Manager and Work stream
Leads
Ensure that the project in on
target and meets its approved
objectives
Sign off on key project
milestones / deliverables
Monitor for changes in the
external environment that may
impact on the project
Play an advocate role across
the Hospital for the project
Project manager
•
•
•
•
•
•
•
•
•
•
•
Leads the project on a day-today basis
Ensures that the overall
project is appropriately
structured into work streams
Drives overall project plan &
project direction
Monitors the progress of all
work streams
Ensures project meetings with
Work stream Leads takes place
on a weekly basis
Develops Steering Group
Update / Report
Ensures an appropriate
stakeholder and cross hospital
engagement plan is
established and is
implemented
Manages overall project risks
and issues
Reports to project sponsor on
a weekly basis
Escalates to Steering Group
risk and issues where
appropriate
Play an advocate role across
the Hospital for the project
Project Team
•
•
•
•
•
•
Responsible for planning
of the project
Provides the relevant
leadership & expertise
from specialist areas
Represents the interests
of stakeholders in Clinical
areas
Identifies opportunities in
EWS project & takes the
lead in implementing
these
Directly works on a work
stream tasks on a day to
day basis
Reports on a weekly basis
to the project team &
communicates all relevant
information clearly to the
project team
Workstream Leads
•
•
•
•
•
•
Leads the work stream on a
day-to-day basis involving
team members as
appropriate
Monitors the progress of all
activities within the work
stream plan in conjunction
with the project manager
Develops & submits to the
project manager a weekly
status report on progress
during the week
Ensures an appropriate
stakeholder and
engagement plan is
established and is
implemented with respect to
the work stream
Liaises with other key
stakeholders as required
who impact on the project
Interacts with and involve
the project team in the
activities of the work stream
13
NEWS
Project Structure
HSE
NEWS National Steering Comm
NEWS Project Steering Group
(see next slide
for suggested membership)
Hospital
Clinical/ Senior Exec
Leadership Team
Hospital PMO
AMP
Steering Comm
Project Manager
……………………..
NEWS Project Team
Project Support
Quality
Assurance
Administrative
Support
Workstream
Groups
EWS Project Steering Group as appropriate to hospital
(Suggested Membership)
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
………………….Project Sponsor
…………………Clinical Director Medicine
…………………Anaesthetist
…………………ED Consultant
…………………Resuscitation Officer
……………….. Consultant (Surgical)
………………….Clinical Governance Manager (IQS)
………………….ICT Director
………………… Financial Controller
………………… Practice Development Co-ordinator
…………………..Medicine Directorate Nurse Manager
………………….Surgical Directorate Nurse Manager
………………….Specialist areas Directorate Nurse managers
………………….Critical Care Directorate Nurse Manager
…………………..Physiotherapy Manager
………….........Out of Hrs Nursing Representative
………………….Associated Third Level Lecturer (Nursing and/or Medical)
NEWS Project Phasing :
The EWS project will be rolled out in …………………………… on a phased basis
Phase 1 of the project (Timeframe) will deliver:
-Review & design of an appropriate observation chart incorporating ViEWS parameters
for use in ……………………………
-Development of Emergency Response System e.g. MET team integrating with existing
arrangements
-Development of an NEWS policy incorporating escalation protocol and
communication tool (ISBAR)
-Train the trainer Programme for identified Medical & Nursing EWS programme
trainers
-Rollout of COMPASS education programme to clinical staff on selected pilot site(s)
- Development of audit tool
-Pilot ………………………………..(timeframe)
-Evaluation of outcome of pilot
Phase 2
Hospital rollout to begin ……………………………(tmeframe)
Phase 3
Implementation of later phases
Project Workstreams
Project Manager…………………………….
NEWS Policy & Obs
chart
Emergency
Response System
Lead: ………..
Lead: …………….
Work stream lead
supported by Practice
dev, Clinical governance,
Medical leadership
Objective: To support the
development &
implementation of NEWS
and related systems into
clinical practice in
………………. Hospital.
-NEWS policy
development
-Obs chart /fNEWS sign off
Work stream lead supported
by Medical & Nursing
Mgmt
Objective: To design
composition of ERS / MET
and develop supporting
escalation protocol
incorporating EWS trigger
and communication tool
-Escalation protocol
agreement
-Emergency Response
System
- Communication tool sign
Nursing: All inpatient
areas Dir reps
ED
ITU
Out of hours
Clinical Governance
Medical: Physicians
/Surgeons, Critical Care
Medicine : as appropriate
to hospital Respiratory,
Cardiology , other
Anaesthetics, Surgeons
Critical Care Nursing
Out of Hours Nursing
ICT
Education
Lead: Medical /Nursing
Work stream lead supported
by Nurse Education, Practice
Development & Medical
Tutors
Objective: To provide clinical staff
with an understanding of the
underlying physiology of acutely
unwell patients, clear guidelines
on the measurement of vital
signs & the documentation &,
escalation /communication of
triggered NEWS to appropriate
medical personnel
- Train the trainer
- Rollout of COMPASS
programme incorporating ISBAR
communication tool
- -Documentation process
NCHD Trainers
Nurse Education/ Practice
Development
ACLS instructors
Identified Cnm’s/SN’s
AHP’s
Evaluation & Audit
Lead:
Work stream lead supported
by Clinical Governance &
Practice Development
Objective:
To develop and implement
appropriate evaluation &
clinical audit systems to
support the continuous
quality improvement
process in relation to
implementation of the
NEWS system.
Nursing: Practice dev,
Senior Medical support
Ward Managers
ITU, Audit nurse
RTO input
ICT
Project Plan - suggest Gannt Chart
• Use the Implementation Plan provided on the
NEWS website below as a guide for the
development of a phased roll out of the NEWS
in the Hospital.
• Identifying key milestones, timelines, planning
targets – tasks completed, planned etc
• Task requiring urgent action etc
• www.hse.ie/go/nationalearlywarningscore/
Key Assumptions
• Senior Medical & Clinical Managers will support the EWS project
implementation
• Medical and clinical staff will support the practice changes
required by the project
• Budgetary and other resources including Human resources will
be made available to the project and will not impact on
timelines
• Staff will be released to attend training
• Trainers/Instructors will be released to provide training
• There will be no delays in getting training for additional ‘Train
the Trainer’ staff
• The AMP project will support the NEWS project as required.
Clinical Risk Assessment and KPI’s
• Clinical Risk assessment will be key to
prioritising areas for immediate
implementation of the NEWS
• Identification of Key Performance Indicators
(KPI’s) to assess performance patient safety
and quality of care is recommended.