Pediatric Early Warning Score (PEWS)

Transcription

1 Lehigh Valley Health Network LVHN Scholarly Works Patient Care Services / Nursing Pediatric Early Warning Score (PEWS) Emily Keim BSN, RN Lehigh Valley Health Network Jennifer Senske BSN, RN Lehigh Valley Health Network Follow this and additional works at: Part of the Nursing Commons Published In/Presented At Keim, E., Senske, J. (2014, June 5). Pediatric Early Warning Score (PEWS). Poster presented at LVHN UHC/AACN Nurse Residency Program Graduation, Lehigh Valley Health Network, Allentown, PA This Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by an authorized administrator. For more information, please contact LibraryServices@lvhn.org.

2 PEWS Photo Credit: Emily Keim RN, BSN (Pediatric ICU) Jennifer Senske RN, BSN (Pediatric Medical-Surgical Unit)

3 Purpose Project Purpose: * To implement Pediatric Early Warning Score to help better detect clinical deterioration among pediatric medicalsurgical patients. *To reduce events among this population such as RRT, codes, and transfers to higher level of care or readmission to higher level of care.

4 PICO QUESTION PICO Question In hospitalized pediatric patients(p), does using the pediatric early warning score (I) compared to not using the score(c) affect caregivers ability to predict clinical deterioration(o) (as evidenced by increase respiratory rate, increase work of breathing, increase in oxygen requirement) in hospitalized pediatric patients.

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6 (Demmel et al, 2010)

7 EVIDENCE 85% of patients who had a rapid response or code event had a critical PEWS within 24 hours before rapid response or code. The median first critical PEWS was 696 minutes prior to event (Akre et al., 2010). For TCH PAWS,80% of patients with a score of 5 or higher had a rapid response event later (Bell et al., 2013). Bedside PEWS scores increased from 12 hours prior to PICU admission to 3 Hours prior to PICU admission (Parshuram, Hutchinson & Middaugh, 2009). Bedside PEWS able to identify patients at risk for code event or urgent ICU admission with at least one hours notice (Parshuram et al., 2011)

8 EVIDENCE In a prospective investigation of in-hospital pediatric cardiopulmonary resuscitation 61% of pediatric cardiac arrests were caused by respiratory failure and 29% were caused by shock. (Solevag et al., 2013) The use of a modified PEWS score can help identify patients on medical wards who are at risk for deterioration. (Skaletzky et al, 2012) Implementing the PEWS alone does not guarantee that the appropriate action will be taken when a child is clinically deteriorating. Developing and implementing an algorithm that linked specific multidisciplinary care allowed all team members to predict responses expected of various colleagues. (Demmel et al, 2010) High PEWS are predicative of patients who will require transfer to the PICU. (Tucker et al., 2008)

9 BARRIERS & STRATEGIES Barrier: Compliance and buy-in of staff for completing extra documentation Strategy to Overcome: Encourage stakeholders to educate and promote PEWS among staff (TLC), meet with core charge, have multi-disciplinary buy-in, attempt to get score added to computerized documentation

10 Expected Outcomes Decrease the amount of transfers from Peds to PICU Decrease in readmission to PICU Decrease the amount of RRT/Code events Provide nurses with a numerical indicator of clinical deterioration Multi-disciplinary buy-in and better clinical outcomes for our patients!

11 PROJECT PLANS Create TLC and meet with core charge and physicians to educate Create form for documentation Implement on the Unit

12 References Akre, M., Finkelstein, M., Erickson, M., Liu, M., Vanderbilt, L., & Billman, G. (2010). Sensitivity of the Pediatric Early Warning Score to identify patient deterioration. Pediatrics, 125(4), e doi: /peds Bell, D., Mac, A., Ochoa, Y., Gordon, M., Gregurich, M., & Taylor, T. (2013). The Texas Children s Hospital Pediatric Advanced Warning Score as a Predictor of Clinical Deterioration in Hospitalized Infants and Children: A Modification of the PEWS Tool. Journal Of Pediatric Nursing, 28(6), e2-9. doi: /j.pedn Demmel, K., Williams, L., Flesch, L. (2010) Implementation of the pediatric early warning scoring system on a pediatric hematology/oncology unit. Journal of Pediatric Oncology Nursing. 27(4) Parshuram, C., Duncan, H., Joffe, A., Farrell, C., Lacroix, J., Middaugh, K., &... Parkin, P. (2011). Multicentre validation of the bedside paediatric early warning system score: a severity of illness score to detect evolving critical illness in hospitalised children. Critical Care, 15(4), R184.

13 References Parshuram, C., Hutchison, J., & Middaugh, K. (2009). Development and initial validation of the Bedside Paediatric Early Warning System score. Critical Care, 13(4), R135. doi: /cc7998 Skaletzky, S., Raszynski, A., Totapally, B. (2012) Validation of a modified pediatric early warning system score: a retrospective case-control study. Clinical Pediatrics. 51(5) Solevag, A., Eggen, E., Schroder, J., Nakstad, B. (2013) Use of modified pediatric early warning score in a department of pediatric and adolescent medicine. PLOS. 8(8) Tucker, K., Brewer, T., Baker, R., Demeritt, B., Vossmeyer, M. (2008) Prospective evaulation of a pediatric inpatient early warning score. JSPN. 14(2)

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