This study aimed to develop and implement a modified Early Warning System (TEWS) including end-of-life care. The effectiveness of its implementation was evaluated in nursing practice. Twenty-nine nurses and 88 patients with gastric or esophageal cancer who were expected to stay in the hospital for more than one week were enrolled. Nurses scored the vital signs and provided care according to TEWS. The implementation of TEWS was evaluated based on the following outcomes: changes in technical independence and anxiety/difficulty of nurses, and information sharing within the team related to patient deterioration, and unexpected adverse events. The results showed that TEWS significantly improved the degree of technical independence (judgment of deterioration risk, conduct a case conference, suggestion of end-of-life consideration to doctors), anxiety/difficulty (observation of critically ill patients, explanation of exacerbation risk to the patient and family) (p=0.0001 to 0.044), and information sharing within the team. No significant increase in adverse events was observed. In conclusion, the implementation of TEWS effectively improved nursing practice, suggesting that information sharing strengthened team approach. Moreover, it can prevent patient deterioration and improve decision-making in end-of-life care.
