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Early detection of clinical deterioration in a pediatric intermediate care unit: a best practice implementation
Céline Lomme1,2,3, Chantal Grandjean1, Vivianne Chanez1
1Pediatric Intermediate Care Unit, Department Women-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland.
Insights
Implementing the Pediatric Early Warning Score (PEWS) in pediatric intermediate care units improved patient safety and staff satisfaction. This score effectively reduces adverse events and enhances clinical deterioration identification.
Area of Science:
- Pediatric critical care medicine
- Healthcare quality improvement
- Patient safety research
Background:
- Pediatric Intermediate Care Units (Ped-IMC) manage high-risk children requiring specialized monitoring.
- The Pediatric Early Warning Score (PEWS) aids in predicting and responding to clinical deterioration.
- PEWS implementation aims to reduce adverse events and improve patient outcomes.
Purpose of the Study:
- To enhance early identification of clinical deterioration in Ped-IMC.
- To improve interprofessional response to deteriorating pediatric patients.
- To implement best practices for patient safety in Ped-IMC.
Main Methods:
- Utilized the JBI Evidence Implementation Framework for project execution.
- Conducted baseline and 6-month follow-up audits to assess practice changes.
- Employed staff surveys and the Assessment of Interprofessional Team Collaboration Scale (AITCS) to measure impact.
Main Results:
- No cardiopulmonary events occurred post-implementation; unplanned PICU transfers decreased.
- Staff job satisfaction increased from 88% to 97%; feeling listened to improved from 84% to 90%.
- Compliance with audit criteria improved significantly, reaching 100% for key indicators.
Conclusions:
- PEWS implementation is feasible and effective in improving patient safety in Ped-IMC.
- The study demonstrated positive impacts on safety culture, adverse event reduction, and staff satisfaction.
- Continued monitoring is essential to ensure the sustained reliability of PEWS in clinical practice.
Background:
The Pediatric Intermediate Care Unit (Ped-IMC) provides specialized monitoring and care for children at high risk of clinical deterioration. The Pediatric Early Warning Score (PEWS) assesses key factors, such as vital signs and concerns from parents and nursing staff. The score helps to predict clinical deterioration, trigger a rapid interprofessional response, reduce morbidity and mortality, and enhance staff safety.
Objective:
This project aimed to promote the prompt identification of clinical deterioration and boost interprofessional response in a Ped-IMC through the implementation of best practices.
Methods:
This project used the JBI Evidence Implementation Framework. A baseline audit was conducted to measure current practices against best practices. A follow-up audit was conducted 6 months after implementation to measure change. The audits investigated cardiopulmonary events and unplanned transfers to the pediatric intensive care unit (PICU). A staff survey measured sense of safety, and the Assessment of Interprofessional Team Collaboration Scale (AITCS) was used to measure job satisfaction and interprofessional collaboration.
Results:
After implementation, no cardiopulmonary events occurred (compared to one before implementation), and unplanned PICU transfers decreased from 17 (5%) to 14 (4%). Half of the medical and nursing staff (n = 30) completed the survey: interprofessional collaboration scores were stable, and job satisfaction increased from 88% to 97%. Health care providers reported feeling more listened to, with scores improving from 84% to 90%, while their sense of safety remained stable. Compliance with audit criteria increased from 0% to 100% for criteria 1 to 4, and from 0% to 24% for criterion 5.
Conclusion:
Implementing PEWS was feasible and effective in enhancing patient safety. While results showed promising improvements in safety culture, reduced adverse events, and increased staff satisfaction, continued monitoring and long-term evaluations are necessary to ensure that PEWS remains a reliable tool in clinical practice.
Spanish Abstract:
http://links.lww.com/IJEBH/A423.
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