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Missed opportunities: incomplete and inaccurate recording of paediatric early warning scores
Susan M Chapman1,2, Kate Oulton3, Mark John Peters2,4
1International and Private Patients, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
Insights
Incomplete and inaccurate paediatric early warning scores (PEWS) hinder the recognition of deteriorating hospitalized children. Ensuring complete and accurate PEWS recording is crucial for timely intervention.
Area of Science:
- Pediatric critical care medicine
- Clinical informatics
- Patient safety
Background:
- Paediatric early warning scores (PEWS) are vital tools for identifying deteriorating hospitalized children.
- Current understanding of how healthcare staff utilize PEWS systems remains limited.
Purpose of the Study:
- To assess the completeness and accuracy of PEWS recording in pediatric patients at a tertiary children's hospital.
- To identify potential deficiencies in PEWS data collection and scoring.
Main Methods:
- Retrospective analysis of case-controlled study data.
- Inclusion of 297 critical deterioration events and matched controls.
- Evaluation of PEWS charts for completeness and accuracy in the 48 hours preceding events.
Main Results:
- Only 35.9% of observation sets were complete with vital signs and PEWS.
- Errors were more frequent in case patients (19.5%) than controls (14.1%).
- Clinically significant inaccuracies, potentially altering escalation, occurred in 9.1% of case patients.
Conclusions:
- Incomplete and inaccurate PEWS recording can compromise the early recognition of child deterioration.
- Technological solutions may be effective in improving PEWS data integrity.
Background:
Paediatric early warning scores (PEWS) are widely used as an adjunct to support staff in recognising deterioration in hospitalised children. Relatively little is known about how staff use these systems.
Objective:
To examine the completeness and accuracy of PEWS recording in hospitalised children in a tertiary specialist children's hospital.
Design:
This is a secondary analysis of retrospective, case-controlled study data. Case patients suffering from a critical deterioration event were matched with controls present on the same ward at the same time and matched for age. Data were extracted from the PEWS chart for the 48 hours before the critical deterioration event for case patients and the corresponding 48 hours period for the control. Observation sets were assessed for completeness and accuracy of PEWS scoring.
Results:
In total 297 case events in 224 patients were available for analysis. Overall 13 816 observations sets were performed, 8543 on cases and 5273 on controls. Only 4958 (35.9%) of observation sets contained a complete set of vital sign parameters and a concurrent PEWS. Errors were more prevalent in the observation sets of case patients versus controls (19.5% vs 14.1%). More errors resulted in the PEWS value being underscored rather than overscored for all observation sets (p<0.0001). 9.1% of inaccuracies for case patients were clinically significant, as the accurately calculated PEWS would have prompted a different escalation from the documented value.
Conclusion:
Failure to record complete and accurate PEWS may jeopardise recognition of children who are deteriorating. Technology may offer an effective solution.
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