Roisin McLoughlin
RGN BSc MSc
Centre for Nursing and Midwifery Education,
Donegal

Organisational change management
development project

Organisational Context

Developing the scope of the HCA role

National HCA NEWS education programme
2
To facilitate a process whereby nominated health care assistants (HCAs)
would be educated to competently measure, record and communicate
patients vital signs including calculating and recording a total EWS using
the Adult Patient Observation Chart, and facilitated to safely perform
these skills.
OBJECTIVES

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
3

Initiation

Planning

Implementing

Mainstreaming
The four key Stages
HSE Change Model (2008)
4









Local Ethics Committee Approval 14/10/2014
Literature Review
Methodology
Force Field Analysis
Stakeholder Analysis
Consultation with a range of key stakeholders – Clinical
Nurse Managers were key
Application and selection process of HCAs – National
Pre Requisites
Identifying Registered Nurse Mentors
Evaluation Process
5

Literature based on documentation of observations and EWS published
during 2009 – 2014 which included studies of HCAs and EWS or track and
trigger systems within a general ward setting.

The electronic databases searched included CINAHL, Cochrane, Medline, Pub
Med and Web of Science.

Limited results: Search was expanded to include literature published from
2005 – 2014

A total of 33 articles were selected. Grey literature sources were searched
and 10 relevant government agencies documents were used.

Exclusion
Papers with reference to Maternity early warning scores (MEWS) or Paediatric
(PEWS) and EWS within critical care areas
6

Patient Safety and Suboptimal Care

Monitoring and Recording Vital Signs and EWS


Education and Training in Vital Signs
monitoring and EWS
Delegation and Competence
7
PLANNING

Letter of invitation to HCAs

Information on project

Signed Consent

Pre Questionnaire

Project Timeline: October 2014- April 2015

Review Guidelines and Policy
8
Summary of the data collection methods utilised in this project
9

Delivery of HCA NEWS Education programme

Six weeks supervised practice & skills demonstration in the
clinical area.

Independent Self Audit over a two month period

HCAs to complete an ISBAR record of Documentation and
Communication

A full set of vital signs must be recorded each time and
documented on the EWS Observation Chart.

Every entry must be dated (Day, Month and Year), timed (using
the 24hr Clock), complete with Initials & Grade HCA.
10
11
After successfully being assessed competent on 10 occasions,
the HCA could measure the vital signs as delegated under the
delegation procedure. Each time they measured and recorded
vital signs, they maintained a self audit form.
12
600
500
400
300
Days (08:00 - 17:00)
Evenings (17:00 - 21:00)
200
Nights(21:00 - 08:00)
100
0
Total number of
Total number of
Total number of
Total number of
EWS scores
EWS scores
EWS scores
EWS scores
recorded
recorded as 0
recorded between
recorded above 3
1-3
13

On recording a EWS of greater than 2 or a new score of 1 the
HCA was asked to complete this record which was used to
communicate a patients total EWS to the RN. Both the HCA
and the RN signed the record and this was placed in the
Nursing documentation.

Education was also necessary for nurse mentors so that they
were familiar with the Delegating Procedure and the scope of
the project.

These education sessions took place on the six clinical areas
14
A system for the HCAs to report findings to the Registered Nurse
and to document in the nursing record was developed in Tallaght
Hospital and reproduces with kind permission.
A report sheet was developed, designed to be printed on sticky
paper and placed into the nursing record when complete.
Tallaght Hospital Dublin
Health Care Assistant Report of Early Warning Score (EWS)
EWS Score:
Date__/___/_____
Time________
Trigger (please tick)
Respiratory
rate:
O2 saturations:
Oxygen therapy:
Inspired O2:
Heart rate:
Systolic BP:
Conscious level
Temperature:
Verbally Reported to:
Grade__________________
Nurse PIN________________
Reported By:
Grade____________________
Registration No.:__________
Signature____________________
Signature____________________
15
December 2014, February 2015, March 2015
16
FOCUS GROUS: Overview of themes and sub themes
17

Positive impact on staff

Improved communication

Improved Teamwork

Increased Confidence in Caring

More involvement with the patient

Created more awareness

Value of HCA reinforced

The benefits to the patients mostly found at night time where
it was felt that the night duty role is more clearly defined
18

FETAC/QQI FET Level 5 Trained HCAs versus HCAs

Skill Mix: Deployment of trained Staff Planning rotas;
Compromising skill mix

Delegation and Competence

Competing work - Lack of practice opportunities on day
shifts e.g. Student nurses

Need to maintain skill through regular engagement in
practice
19


The RN continues monitoring and supervising the HCA to
demonstrate, develop and maintain competency in undertaking,
recording, totaling, and communicating a patients’ vital signs
and EWS. This will ensure that skills are maintained and are
embedded in safe practice.
Continuous evidence in the workplace to demonstrate that:
– Patients needs are the priority and patient centred care is evident
– Staff are empowered and committed
- Policy, protocols and guidelines is adhered to
– Quality Standards and goals are achieved (individual, team,
organisational effectiveness)

A review of the effectiveness of the HCAs role in undertaking
the skill of HCA-NEWS is completed at local and national level.
20



Ongoing audit and evaluation should continue to determine
- Totalling of EWS and the completeness of observation charts
- That patients have a minimum of 12hourly observations
recorded
- Increased monitoring as per clinical protocol is adhered to
- That the skill has been undertaken by the right person in
accordance with the patients’ condition
Standardisation of HCA’s recording and documenting clinical
practices in nursing documentation and patients’ charts is used
to record patient information.
There is a need for all HCAs to be trained to the same level to
maintain standards and ensure clarity of roles and
responsibilities.
21



For further information please contact
roisin.mcloughlin@hse.ie
References available on request
Dissertation available on E-publications@rcsi.ie
22