• Chris Carter.
• Intensive Care Nursing Officer, 16 Medical Regiment, Merville Barracks, Colchester, Essex, UK.
• J R Army Med Corps. 2013 Dec 1; 159 (4): 283-6.

ObjectivesTo determine whether full sets of physiological observations and the Defence Medical Services (DMS) Early Warning Scoring (EWS) tool were applied to patients admitted to the ward at the UK Role 3 Field Hospital in Afghanistan.MethodsAt the start of a 3-month deployment to the Role 3 facility, 40 ward observation charts were reviewed in the first phase of the audit to determine the compliance and accuracy of completion of the DMS EWS. Following implementation of a change management programme the audit was repeated 3 months later in the same ward and staffing environment.ResultsThe initial audit identified DMS EWS compliance to be 52.5% with an accuracy of 33%. A change management programme was instigated using feedback and teaching sessions for the ward staff and compliance and accuracy increased to 80% and 59% respectively when reaudited. Both audits identified that the majority of core observations (respiratory rate, oxygen saturations, pulse, blood pressure and temperature) were well recorded, whereas neurological status and urine output were poorly recorded.ConclusionsThis pilot audit has provided an insight into the recording of physiological observations and use of the DMS EWS within a deployed field hospital. It demonstrated core observations were well recorded in data collection periods and while compliance with using the DMS EWS increased, accuracy remained less than 50%. The DMS EWS is one tool used by healthcare professionals to recognise and respond to the deteriorating patient and incorrect use of this tool or failure to use it at all is a significant patient safety issue.

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