BC Provincial Pediatric Early Warning System PEWS What
BC Provincial Pediatric Early Warning System (PEWS) What physicians need to know… November 5, 2015 Presenter: Dr. Erik Swartz Content: Maureen O’Donnell, Theresa Mc. Elroy, Melissa Sallows, & Yasmin Tuff
Why do we need earlier warning of a child’s compromise? ü~63 to 89% of children do not survive cardiac arrest üMorbidity in survivors remains high despite advances in resuscitation training, technology and treatment üEvidence indicates prevention is possible üPediatric patients may demonstrate physiologic and behavioral symptom deterioration up to 24 hours prior to cardiopulmonary arrest Early Recognition Early Intervention Improved outcomes
How can we get earlier attention? Introduce a system that has become a quality standard across the world… PEWS Identify Communicate Mitigate/ Escalate PEWS Score >2 Our hope is to identify patients sooner rather than later in their illness trajectory. Courtesy of BC Children's Hospital
What is the BC PEW system? A standardized, evidence-based system for recognition and response to deterioration… 1. PEWS Score (in a bedside flow sheet) 4. Communication framework (SBAR) 2. Situational awareness bundle 3. PEWS escalation aid
1. Brighton PEWS Scoring Table Score can range between 0 and 13. Higher PEWS scores associated with higher risk of clinical deterioration
Flow Sheet & PEWS Score PEWS Scoring Legend 0 1 2 3 Age- specific vital signs norms based on CTAS 2013
2. Situational Awareness -factors that contribute to the risk of pediatric clinical deterioration Caregiver Concern Unusual therapy PEWS score 2+ Watcher patient Communication breakdown Cincinnati Children’s found these factors to be 100% sensitive predictors of serious deterioration. Addressing all five on a regular basis helped teams improve predicting & preventing deterioration 7
3. Escalation Aid
4. SBAR Improve & Standardize Communication S • Situation B • Background A • Assessment R • Recommendation …a framework for communication between health care team members regarding a patient's condition 9
Creating a Common & Clear Picture of Risk Standardized check-in processes between charge nurse and RNs Visual cues for care providers of patients deemed at risk (Room number/bed on white board colored in red) 10
On the cutting edge… Standardizing PEWS in BC • PEWS is for all inpatients regardless of acuity • It is a support for clinical decision making but not a substitute for clinical judgment • Promotes a consistent standard of care for pediatric patients across BC • Provides a common language and benchmark for pediatric care • Facilitates safe transitions 11
Do the PEWS tools work? What has research found? • Nearly 50% decrease in rates of UNSAFE ICU transfers • Potentially provides advanced time of >11 hours • Positive directional trends in improved clinical outcomes • Enhanced multi-disciplinary team work, communication and confidence • There are no negative outcomes reported in the literature related to the use of PEWS 12
How will we know if PEWS is working? 15 sites PEWS ? ü Mixed method, pre-post evaluation design: chart reviews, interviews, focus groups and surveys at all phase 1 sites. 13
Case Study: Example Baby Smith: • 5 -month-old admitted with RSV • Previously vigorous in her activity-now lethargic • Mom calls for the nurse as she is very concerned • RR 70 with increased use of accessory muscles • Sa. O 2 is 95% on 1 L/min of NP • HR 160, she is pale, cap refill is 4 seconds, BP 82/46 What is this patient’s PEWS score?
Respiratory Score PEWS Scoring Legend x 0 1 2 3 95% 1 L NP x 2 Always use the score from the highest descriptor per category
Cardiovascular Score PEWS Scoring Legend x Always use the score from the highest descriptor per category 0 1 2 3 x x 2
Behavior Score PEWS Scoring Legend 0 1 x 2 3 3
Total PEWS Score 2 3 3 00 8
CASE STUDY Questions • Are any Situational Awareness factors present? • Based on the Escalation Aid what actions will the nurse need to take? • Referring to the Escalation Aid what are your responsibilities as the physician caring for this patient? 19
Questions? 20
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