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Implementation of Pediatric Early Warning Score; Adherence to Guidelines and Influence of Context
Ann-Charlotte Almblad1, Petra Siltberg1, Gunn Engvall1
1Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
Insights
Pediatric Early Warning Score (PEWS) implementation showed frequent use, but incomplete documentation of actions for high scores. Adherence to guidelines varied, suggesting context impacts effectiveness in pediatric patient safety.
Area of Science:
- Pediatric critical care
- Healthcare quality improvement
- Clinical informatics
Background:
- The Pediatric Early Warning Score (PEWS) is a tool to identify at-risk children.
- Early Detection and Treatment-Children (EDT-C) is a concept integrating PEWS into clinical practice.
- Assessing the implementation and adherence to PEWS guidelines is crucial for patient safety.
Purpose of the Study:
- To describe Pediatric Early Warning Score (PEWS) registration data.
- To evaluate the implementation of PEWS by examining adherence to clinical guidelines.
- To relate PEWS findings to the healthcare work context.
Main Methods:
- PEWS was implemented as part of EDT-C across three pediatric hospital wards.
- Retrospective data collection from Electronic Patient Records (EPR) assessed guideline adherence.
- The Alberta Context Tool (ACT) surveyed healthcare professionals (n=109) on work context.
Main Results:
- Most PEWS registrations were low; 10% were moderate to high.
- High adherence was observed for admission and respiratory distress guidelines, but low for pain assessment.
- Significant inter-ward variations in documented actions, leadership, and evaluation were noted.
Conclusions:
- PEWS was frequently used, identifying potential high-risk patients (28 instances of scores 5-9).
- Incomplete documentation of recommended actions and variable guideline adherence were observed.
- Workplace contextual factors likely influence adherence to PEWS guidelines.
Purpose:
To describe data of Pediatric Early Warning Score (PEWS) registrations and to evaluate the implementation of PEWS by examining adherence to clinical guidelines based on measured PEWS, and to relate findings to work context.
Design And Methods:
PEWS, as a part of a concept called Early Detection and Treatment-Children (EDT-C) was implemented at three wards at a Children's Hospital in Sweden. Data were collected from the Electronic Patient Record (EPR) retrospectively to assess adherence to guidelines. The Alberta Context Tool (ACT) was used to assess work context among healthcare professionals (n=109) before implementation of EDT-C.
Results:
The majority of PEWS registrations in EPR were low whereas 10% were moderate to high. Adherences to ward-specific guidelines at admission and for saturation in respiratory distress were high whereas adherence to pain assessment was low. There were significant differences in documented recommended actions between wards. Some differences in leadership and evaluation between wards were identified.
Conclusions:
Evaluation of PEWS implementation indicated frequent use of the tool despite most scores being low. High scores (5-9) occurred 28 times, which may indicate that patients with a high risk of clinical deterioration were identified. Documentation of the consequent recommended actions was however incomplete and there was a large variation in adherence to guidelines. Contextual factors may have an impact on adherence.
Practice Implications:
EDT-C can lead to increased knowledge about early detection of deterioration, strengthen nurses as professionals, optimize treatment and teamwork and thereby increase patient safety for children treated in hospitals.
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