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How to implement a PEWS in a resource-limited setting: A quantitative analysis of the bedside-PEWS implementation in
Karin S van der Fluit1, Matthijs C Boom1, Marlon B Brandão2,3
1Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands.
Insights
Implementing a bedside paediatric early warning system (B-PEWS) in resource-limited settings is feasible, showing significant improvements in implementation rates and scoring accuracy. Dedicated teams are crucial for success, despite workflow challenges.
Area of Science:
- Pediatric critical care
- Healthcare system implementation
- Resource-limited healthcare settings
Background:
- The bedside paediatric early warning system (B-PEWS) is designed to identify hospitalized children at risk of cardiopulmonary arrest for timely critical care.
- Implementation of such systems in resource-limited settings presents unique challenges.
Purpose of the Study:
- To quantitatively analyze the implementation of the B-PEWS in a resource-limited setting.
- To assess the impact of B-PEWS on patient identification and care.
Main Methods:
- A retrospective review of medical records from a philanthropic hospital in Brazil was conducted.
- Nurses' performance using the B-PEWS was evaluated over a 21-week period, comparing two implementation phases.
Main Results:
- The study included 499 patients and analyzed 8024 scores.
- Implementation rates increased significantly from 66.5% to 93.1%.
- Correct scoring accuracy improved from 7.5% to 32.2% (p < 0.001), with better age group selection.
Conclusions:
- Successful B-PEWS implementation is achievable in resource-limited environments with high adoption rates.
- A dedicated and active implementation team is vital for success.
- Workflow changes and language barriers were identified as potential implementation hindrances.
Objectives:
Quantitative analysis of the implementation of the bedside paediatric early warning system (B-PEWS) in a resource-limited setting. The B-PEWS serves to pre-emptively identify hospitalised children who are at risk for cardiopulmonary arrest and subsequently to provide critical care in time.
Methods:
We performed a retrospective review through the medical data records of patients after discharge from the paediatric ward of a philanthropic hospital in Brazil. Nurses' performance using the system was measured with various parameters.
Results:
A total of 499 patients were included, and a total of 8024 scores were checked. During the 21-week research period, the implementation rate increased significantly from 66.5% (SD 26.0) in Period 1 to 93.1% (SD 16.6) in Period 2. The number of scores that resulted in a correct total score went from 7.5% in Period 1 to 32.2% in Period 2, p < 0.001. There was an improvement in the correct choice of age group between the two periods (from 32.2% to 53.4%). There was no difference in the mean admission time of patients in the two periods: in the first period 4.8 days (SD 2.9) and in the second period 4.8 days (SD 4.1).
Conclusions:
It is possible to implement a PEWS in resource-limited settings while achieving high implementation rates. However, this is a time- and energy-consuming process. Having an active and involved team that is responsible for implementation is key for a successful implementation. Factors that likely hindered implementation were a large change in workflow for the nursing staff, non-native speakers as main investigators.
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