Citation: Smith, D. J. & Aitken, L. M. (2016). Use of a single parameter track and trigger chart and the perceived barriers and facilitators to escalation of a deteriorating ward patient: a mixed methods study. Journal of Clinical Nursing, 25(1-2), pp. 175-185. doi: 10.1111/jocn.13104 This is the accepted version of the paper.This version of the publication may differ from the final published version. Permanent TITLE:Use of a single parameter track and trigger chart and the perceived barriers and facilitators to escalation of a deteriorating ward patient: a mixed methods study.AUTHOR DETAILS: To investigate nurses' use of a single parameter track and trigger chart to inform implementation of the National Early Warning Scoring tool. Objectives:To report the characteristics of patients with triggers, the frequency of different triggers, and the time taken to repeat observations. To explore the barriers and facilitators perceived by nursing staff relating to patient monitoring.Background:

Aim To explore barriers and enablers of recognition and response to signs of patient deterioration by nursing staff in an acute hospital. Design A theory‐driven interview study underpinned by the Theoretical Domains Framework of behaviour change. Methods Between 07/01/2019 and 18/12/2019 a purposive sample of registered nurses and healthcare assistants was recruited to participate in a semi‐structured (audio‐recorded) interview, to explore the determinants of seven specified behaviours of the afferent limb. Anonymised transcripts were deductively coded (using the 14 Theoretical Domains Framework domains as coding categories) and then extracts within each domain were inductively analysed to synthesise belief statements and themes. Prioritisation criteria from published literature were applied. Results Thirty‐two semi‐structured interviews were conducted. From 1,888 quotes, 184 belief statements and 66 themes were synthesised. One hundred and forty‐six belief statements, represented by 58 themes, met prioritisation criteria. Nine domains of the Theoretical Domains Framework were of high importance: Knowledge; Social, Professional Role and Identity; Beliefs about Consequences; Reinforcement; Intentions; Goals; Memory, Attention and Decision Processes; Environment, Context and Resources and Social Influences. Conclusions Barriers and enablers most likely to impact on nursing staff afferent limb behaviour were identified in nine domains of the Theoretical Domains Framework.

Patients who deteriorate without recognition or timely interventions are at risk of critical care admission and increased morbidity or mortality. This article outlines the systematic ABCDE (airway, breathing, circulation, disability, exposure) approach to patient assessment, which enables healthcare practitioners to identify and respond to life-threatening conditions in order of priority. The patient's vital signs should be measured as part of the ABCDE assessment and recorded using a track and trigger tool to enhance recognition of physiological abnormalities that signal deterioration. To optimise communication and escalation of deteriorating patients, healthcare practitioners should report ABCDE assessment findings using a structured communication tool.