Identifying Patients at Risk for Decompensation Earlier With PEWS

Purpose:
To increase rapid response team (RRT) notifications on the inpatient units using the PEWS (pediatric early warning score)tools to guide assessment, provide interventions earlier and prevent the need for transfer to the peidatric intensive care unit(PICU).

Relevance/Significance:
PEWS and it's adult counterpart, MEWS, have been widely used as a means of using consistent criteria to identify patients at risk for decompensation early to initiate treatment in a timely manner. This initiative has had positive outcomes with implications for practice that have a focus on implementation of best practices and interprofessional, patient centered care.

Strategy and Implementation:
The PEWS team consisting of an interdisciplinary staff of physician and nurses worked to revise the tool and escalation algorithm to better reflect practice. A thorough education for all staff on the tools, the scoring system and proper escalation was conducted using case scenarios and simulated experiences. Frequency of performing PEWS was based on the patient's condition and laid out in the algorithm. PEWS scores were conducted on all patients on the pilot unit Med 2. Data on all RRT on the unit and the corresponding PEWS score at time of RRT were gathered. The escalation algorithm was adjusted based on pilot data to include an automatic rapid response at a PEWS score of 6 or higher. After implementation of this change the pilot continued and the data was analyzed. The change of an automatic rapid response call at PEWS of 6 was found to be an appropriate escalation process.

Evaluation:
In 2014, there was a noted increase in the number of RRT activations, from 240 in 2013 to 328 in 2014, less of the children that had an RRT warranted transfer to PICU. In 2013, 53% of the RRT activations required PICU transfer and in 2014, 45% of the activations required PICU transfer, This translates to a minimum of 21 PICU days saved and an associated cost savings of roughly $52,500-$84,000.

Implications for Practice:
Based on the consistent use of PEWS evaluation, slight changes in vital signs and other signs of potential decompensation are being recognized by staff earlier and the activations are getting the children the support needed sooner and preventing the need for PICU transfer.