Table 3.

Interview guide for focus group interviews

Themes	Interview questions
Briefing and introduction	• Introduction of the interviewers and aim of the interview • Briefing that participation in the interview is voluntary and data will be published anonymized • I ask the participants to briefly introduce themselves by name, place of employment, and how long they have been nurses and worked on the ward
General aspects of knowledge and understandings of acutely deteriorating patients	• In your opinion, what is an acutely deteriorating patient?  ○ Try to describe your last acutely deteriorating patient.  ○ What connections do you see between critical illness and patients’ diagnosis?  ○ What connections do you see between critical illness and patients’ vital signs?  ○ What connections do you see between critical illness and progression in patients’ condition?  ○ What connections do you see between critical illness and patients’ co-morbidities?  ○ In your opinion, are there any other findings that lead you to conclude that a patient is acutely deteriorating?
General aspects of handling acutely deteriorating patients on the wards	• Try to tell how you typically handle acutely deteriorating patients on your ward  ○ What is the role of other nurses?  ○ How do you delegate tasks between doctors and nurses on your wards?  ○ How do you typically identify at risk patients on your wards?  ○ How do you determine how close patients should be monitored on your wards?  ○ How do you decide what interventions and treatments acutely deteriorating patients receive on your wards?  ○ How do you determine if you need further assistance to handle acutely deteriorating patients on your wards?
General aspects of the role of early warning score in identifying and handling acutely deteriorating patients	• In your opinion, what is the role of EWS and the related algorithm in handling acutely deteriorating patients?  ○ Try to describe if and when you use EWS in identifying acutely deteriorating patients.  ○ Try to describe if and when you use EWS in monitoring acutely deteriorating patients.  ○ Try to describe if and when you use EWS in stabilizing acutely deteriorating patients.  ○ Try to describe if and when you use EWS to obtain necessary assistance in handling acutely deteriorating patients.
Specifically about barriers and facilitators in relation to adherence to monitoring frequency	• Try to describe what issues make it easy or hard to adhere to the prescribed monitoring frequency of the EWS algorithm.  ○ In what circumstances would you typically deviate from the algorithm and monitor more or less frequently?  ○ What issues in your daily work life impact on the adherence to the algorithm? • Do you consider it important to adhere to the prescribed monitoring frequency? • What could be done to make it easier to adhere to the prescribed monitoring frequency?
Specifically about barriers and facilitators in relation to inform junior doctors about patients with moderately elevated EWS (≥ 3)	• According to the algorithm junior doctors must be informed about every patient with a moderately elevated EWS of 2–3, what do you think of that?  ○ How often do you inform junior doctors about these patients?  ○ Under what circumstances do you inform junior doctors about these patients?  ○ When do you decide not to inform them?  ○ What issues in your daily work life impact on the adherence to the algorithm? • In your opinion, what is the most important issue that determines whether you do or do not inform junior doctors? • What could be done to make it easier to inform junior doctors?
Specifically about barriers and facilitators in relation to MET calls	• Try to describe when you last made a MET call? • In what circumstances do you use MET?  ○ Are there specific categories of patients where you call MET?  ○ Are there specific times of the day when you use MET?  ○ What criteria do you use to determine whether to call for MET or not?  ○ What issues in your daily work life impact on the adherence to the algorithm in regard to MET calls? • When do you not use MET? • What is the role of EWS in your decision to call MET? • In your opinion, what is the most important issue that determines whether you do or do not inform junior doctors? • What could be done to make it easier to use MET?
Debriefing	• Are there any important issues we need to talk about in regard to acutely deteriorating patients? • Thank you for your participation.