Implementing the National Early Warning Score for Healthcare Assistants (HCA-NEWS) in an Acute Hospital

This organisational development (OD) project centres on the implementation of the National Early Warning Score system for Healthcare Assistants (HCANEWS) in a medical directorate of an acute hospital. Recording and communicating a patient’s vital signs is a cornerstone of nursing practice. Routine patient observations are now delegated to HCAs working under the guidance of registered nurses (RNs). The primary aim of the measurement of vital signs and the use of early warning scoring systems (EWS) is to enhance patient safety. The EWS is calculated as part of the overall vital signs assessment, and should be associated with appropriate and timely communication between the HCA and RN. The HSE Change model framework was used detailing the progression of the change project. A mixed methodology approach was utilised. Questionnaires were sent to HCAs who met the pre-requisites to attend the HCA-NEWS education programme. HCAs were supervised and supported by the RN to complete a period of supervised practice and skills assessment. HCAs undertook a self audit of EWS recordings. To standardise documentation and communication of EWS findings to the RN an ISBAR communication sticker was completed and placed in the nursing documentation. Focus group interviews were conducted with three groups; Clinical Nurse Managers, RNs and HCAs. An audit of documentation of NEWS observations was undertaken using Nursing Quality Care Metrics. Results from data collection methods were in congruence with the literature. The findings indicated increased communication between staff, increased confidence in caring, improved teamwork and further opportunities for HCAs to provide direct patient care. However, the key challenge identified was around deployment of HCA staff that completed EWS training. Building strong collaborative relationships with key stakeholders resulted in motivation, ownership, partnership and commitment to the change. The project has been successfully implemented in the six medical departments of an acute hospital.