Title: Alert Worsening conditions And Report Early (AWARE): A patient education
intervention to enhance the self-efficacy of hospitalized patients on recognition
and reporting of acute deteriorating conditions
Background: Acute deterioration in the general wards is an international health concern that
requires urgent address. Much effort was concentrated on training and
improving the skills of healthcare providers for the initial identification and
management of deteriorating patients based on objective physiological metrics.
To improve the current rapid response system, recent literature have credited
patient reports as the gold standard in measuring symptoms and identified the
need to consider patients as 1) the first recognizer in patient deterioration and; 2)
trigger of the response system even before the abnormal physiological signs are
prominent and detectable by healthcare providers. However, the difficulties and
uncertainties encountered by patients in recognizing their symptoms as serious
could extend delays in the timely escalation of care.
Objective: This study aimed to develop, implement and test the effectiveness of a patient
education intervention in enhancing the self-efficacy of patients to recognize and
report acute deteriorating conditions.
Methods: Using cluster randomization, acute care general wards were randomized to the
experimental and control groups. Convenience sampling was applied to recruit the
67 adult patients from an acute hospital. 34 patients from the experimental group
received a 30-minute patient education intervention on Alert Worsening conditions
and Report Early (AWARE) using the ABCDE
(Airway obstruction,
Breathlessness, Cold, Dizziness, Extreme pain, and Expel and Excrete blood)
mnemonics on recognition and reporting of acute deteriorating conditions while 33
patients in the control group received routine care only. Levels of self-efficacy to
recognize and report symptoms were measured before and after the intervention
using a 10-item Self-Efficacy Response Scale (SERS) questionnaire.
Results: Both groups showed significant improvements in their overall posttest mean scores
compared to pretest. However, levels of self-efficacy reported by the experimental
group were significantly higher than the control group (p < 0.0001).
Conclusion: A one-on-one patient education intervention that utilized the ABCDE mnemonics
has enhanced the self-efficacy of patients to recognize and report acute deterioration.
Patient engagement through patient education could be further explored for purposes
of implementation as part of the present ward routine care and included in the current
rapid response system to enhance patient safety measures and reduce the incidences
of hospital mortality and morbidity in the general wards.
Figures:
Figure 1: ABCDE mnemonic handout in the AWARE intervention
p < 0.0001
60
51.24
p < 0.05
Mean Score
50
40
35.76
36.88
34.45
Pre-test
30
Post-test
20
10
0
Control
Experimental
Figure 2: Pre-posttest mean scores in recognizing and reporting worsening conditions