PEWS one year down the line. Lorraine Major Advanced Paediatric Nurse Practitioner

Transcription

1 PEWS one year down the line Lorraine Major Advanced Paediatric Nurse Practitioner

2 Clinical Incident 3mth old boy born at 30 weeks gestation Tracheo-oesophagel fistula and oesophageal atresia Under shared care with London and regional centre Recent admission for bronchiolitis Inadequate discharge plan Maternal Asperger s syndrome. ED attendance accompanied by mother Triaged within mins by Band 5 general SN ObservationsT,P,R,O2 sats recorded

3 Change our PEWS

4 Realities of the DGH No paediatric nurses in ED Trying to squeeze expert knowledge into novice heads All the undocumented subtle signs of the sick child Rotation doctors and nurses All we have left are VITAL signs

5 Aim Empower staff Educate staff Recognise sick children sooner Prevent avoidable deterioration

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8 What do we do Measured what we were doing in regards to taking Temperature, respiratory rate and pulse. Measured against national standards for taking vital signs in children

9 Teaching Each member of staff re-taught on how to do vital signs Chunks of staff at all times of day and night Agreement on standards

10 Choose the charts Audited three charts with student nurses One came out top

11 Rolled them out

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14 Audit Correct and age appropriate Observations completed Scored Accurately

15 Started July 2011 Dec 2011 After 6mths of use PEWS charts on G2 and CDU 170 charts audited of acute admissions 85 in CDU 85 in G2

16 Correct age appropriate CDU 100% Correct G2 100% Correct

17 Observations Complete CDU CDU 100% correct Majority one two observations at the beginning of the presentation Fewer observations done in the admission

18 Observations complete G2 G2 65% correct Respiratory rate complete Heart rate completed Temperature not so consistent Saturations completed A lot Pts with respiratory tract infections Use of monitor for HR and Sats

19 Scored accurately CDU Scored accurately 55% O not always scored Always score 1 and above

20 Scored accurately G2 Scored accurately 48% Again O missed out and scoring 1 and above When there was the same score over a long period the scoring system failed

21 Pews score and response 2 pts scored 5 on PEWS both respiratory patients and registrar was called on admission to CDU 1pt scored 4 on G2 registrar response IV Salbutamol given. One patient scored 1-2 on PEWS and had meningitis. It was the babies handling and irritability that raised concerns.

22 PEWS score and response 10 pts scored 3 seen by SHO or PANP and treatment activated Parent/nurse/ doctor concern not scored as often as anticipated

23 What s Good? Clear trend and visual improvement in documentation Observation are plotted and written in the appropriate boxes Easy to find in the nursing notes Have been implemented with no problems

24 What s not so Good? Audit part not working only 3 actions documented The example of the temperature dot (38 ) it is sometimes conceived that the child is pyrexial No pain score

25 Changes Add weight to top right hand corner Remove audit box and add? Pain score? SBAR Re-training about the importance of scoring the totals accurately

26 Dec 2011 to July 2012 CDU 70 charts one year after implementation Age appropriate = 100% Observations completed= 86% Scored correctly = 89%

27 Dec 2011 to July charts G2 one year after implementation Age appropriate = 100% Observations completed= 95% Scored correctly = 85%

28 One Sample of Escalation 7 month old admitted Bronchiolitis S/B Dr PEWS score 3 on arrival Inc to 4 at until = Reg review and to be seen by Cons Not seen by Cons Plan O2, Nurse prongs, 1hrly NG

29 Sample of escalation PEWS remained at 3 but the only difference was that the family concern was not scored Otherwise it would have been a 4 the observations were scoring the same until PEWS > 4 post feed then escalation reported and documented Action -nil by mouth NIV and rest

30 Dec 2011 and July 2012 G2 Age appropriate 100% and 100% Observations completed 65% and 95% Scored Accurately 48% and 85%

31 Dec 2011 and July 2012 CDU Age Appropriate 100% and 100% Observation Completed 100% and 86% Scored Accurately 55% and 85%

32 Bad news One escalation not acted on appropriately It only takes one!!!

33 Good News Scoring has improved across the floor The visual look of the charts makes them easier to read Nurses empowered with information and the tools to escalate

34 Keep It Simple (KIS)