A review of one of the most tragic issues in modern nursing homes, failure to detect patient deterioration, used a five-step process to extract and examine data on study aims, key findings, afferent/efferent consequences, and team implementation and practice of rapid response procedure. Ultimately, 23 of 120 potential articles were used in the review, with 15 of those focusing upon afferent limb rapid response systems and 8 focused on both afferent and efferent limbs. 22 potential studies on the topic of effective practice and organization for care taxonomy met criteria for quality and safety improvements, and 19 in the same vein met expectations for referral, outreach, and teams. From this pool of studies, three themes emerged: inconsistent activation of the rapid response teams, barriers to following early warning score system algorithms, and over-reliance upon scores.

Nurses use early warning score systems to identify deteriorating patients and ensure their safety. Unfortunately, work culture, employee confidence, and past experiences all generally increase the rate of global afferent limb failure. Track and trigger charts that employ simple to follow algorithms are often hard for nurses to utilize properly due to heavy workloads and the additional burden of finding medical officers who will review them within a useful and pertinent time frame. Nurses lean upon early warning score systems and tend to neglect algorithm-based treatment opinions, and as a whole do not perform enough holistic examinations. This along with the aforementioned issues in interpersonal characteristics are some of the main barriers to great care discovered by the scoping review.

The original article can be found here.