Related Experiment Video
Updated: Dec 21, 2025
Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Improving Accuracy and Timeliness of Nursing Documentation of Pediatric Early Warning Scores
Nathan P Dean1, Jenhao J Cheng2, Ian Crumbley3
1Department of Pediatrics, Children's National Health System, The George Washington School of Medicine.
Insights
Implementing an electronic health record (EHR) calculator for pediatric early warning scores (PEWS) significantly improved accuracy and reduced documentation time. This digital tool enhances patient safety by ensuring timely identification of deteriorating patients.
Area of Science:
- Pediatric critical care medicine
- Health informatics
- Nursing quality improvement
Background:
- Accurate and timely documentation of pediatric early warning scores (PEWS) is crucial for identifying patient deterioration.
- Manual PEWS calculation by nurses can lead to inaccuracies and delays in documentation within the electronic health record (EHR).
Purpose of the Study:
- To evaluate the impact of an embedded EHR PEWS calculator on score accuracy and documentation time.
- To improve the early identification of deteriorating pediatric patients through enhanced PEWS documentation.
Main Methods:
- Retrospective analysis of 2,409 PEWS scores (November 2013 - December 2016).
- Compared manual PEWS calculation (before September 2015) with EHR-automated calculation (after September 2015).
- Assessed accuracy of cardiac/respiratory subscores and time from vital sign collection to EHR documentation.
Main Results:
- Accuracy improved from 71% with manual calculation to near-perfect with the EHR calculator, eliminating inaccurately low scores.
- Median documentation time decreased from 55 minutes to 20 minutes after EHR calculator implementation.
- The EHR calculator reduced the time lag between vital sign collection and final documentation.
Conclusions:
- Transitioning to an EHR-based PEWS calculator effectively eliminated inaccurately low scores.
- The EHR calculator significantly reduced the median time required for PEWS documentation, enhancing efficiency and potentially patient safety.
Introduction:
Accurate and timely documentation of pediatric early warning scores (PEWS) by the bedside nurse into the electronic health record (EHR) is important to promote early identification of patients in stages of deterioration. Through the implementation of a PEWS calculator embedded in the EHR, we hope to improve the accuracy of the recorded score and reduce the time between vital sign collection and final documentation in the EHR.
Methods:
Identification of the highest PEWS value in the 24 hours before all unplanned transfers or rapid response activations without a transfer occurred between the period November 1, 2013, through December 31, 2016. The accuracy of the calculated cardiac or respiratory subscore based on heart rate or the respiratory rate at the time of PEWS calculation was determined. We tracked the calculation of the time to chart via the difference between nursing documentation of PEWS compared to vital sign collection. Before September 3, 2015, PEWS was calculated mentally by the bedside nurse; afterward, the nurse entered the unique PEWS features into the EHR, and the EHR automatically calculated PEWS.
Results:
This study evaluated 2,409 PEWS scores, 1,411 before and 998 after initiation of the PEWS calculator. Accuracy before the EHR calculator was 71%, and the median time to document was 55 minutes. Following the implementation of the calculator, no scores were incorrectly calculated too low, and the median time to document was 20 minutes.
Conclusions:
Transition to an EHR-based PEWS calculator eliminated inaccurately low PEWS values and reduced time to document.
Related Concept Videos
01:26Guidelines for Nursing Documentation II
Timely documentation is crucial to ensure continuity of care for patients. Any delays in recording or reporting medical information can result in medical errors and even adverse patient outcomes. From medication administration to diagnostic test results, every detail must be accurately and promptly documented to provide the best possible care for patients.
01:30Guidelines for Nursing Documentation I
Factual:
The following points emphasize the significance of upholding accurate and unbiased documentation in healthcare.
01:06Legal Guidelines for Documentation
01:20Introduction to Documentation and Reporting
Nursing documentation records essential information and details regarding a patient's care and treatment in written or electronic form. It is a critical aspect of nursing practice that involves documenting assessments, interventions, outcomes, and other relevant details about a patient's health status.
Documentation maps the patient's health journey by creating a comprehensive...
01:08Role of Communication in the Nursing Process III: Evaluation and Documentation
01:21Methods of Documentation III: PIE