Background/ Why Is This Important?
Global research has shown that failure to recognize and treat deteriorating hospitalized patients is a source of substantive unintended harm, including death, disability, and prolonged stay or readmission. PEWS are used internationally to promote early identification and mitigation of deterioration in hospitalized pediatric patients.
In order to optimize safety, BC Health Authority leaders and clinicians identified the implementation of PEWS as a high priority in hospitals that care for children. The Child Health BC Steering Committee endorsed a standardized approach to the development, implementation and evaluation of PEWS in BC hospitals (BC PEWS). To date, we have completed a phased implementation and evaluation of BC PEWS in hospitals that provide inpatient care to children. A research pilot was also conducted at Richmond Hospital emergency department (ED) to help understand the potential value of using PEWS in the ED.
What is BC PEWS and BC PEWS ED?
A system consisting of 5 components designed for the care setting:
- PEWS score (Brighton) - a risk score based on physiologic assessment
- standardized age-specific pediatric assessment & documentation tools (flowsheets)
- an escalation guide
- a situational awareness bundle (evidence based risk factors)
- a communication framework (SBAR)
Together these system parts are designed to provide a standardized framework and language to identify potential deterioration in a child; mitigate that risk; and escalate care as needed — all as early as possible. This is a unique initiative and the first of its kind in North America where an entire province or state adapts a standardized early warning system for pediatrics.
What Actions Have Already Been Taken?
PEWS have now been implemented in over 44 hospitals in BC who admit pediatric patients. In September 2018, a decision was made to implement PEWS in emergency department settings (BC PEWS ED) following a successful research pilot of PEWS in the Emergency Department at Richmond Hospital. In February 2018, we began developing a standardized approach to the development, implementation and evaluation of BC PEWS ED. Implementation is now underway in sites across the province. This includes:
- A provincial education strategy to ensure a standardized approach to education including online learning modules; regional workshops for clinical pediatric leaders; support for site specific staff training; and physician education resources.
- A coordinated implementation strategy with supporting resources including: presentations; frequently asked questions; and guidelines.
- A robust quality improvement and evaluation strategy to support sustainability.
Where Are We Now?
Evaluation and research has now been completed for phase one sites and Richmond Hospital ED.
BC PEWS Evaluation: A mixed methods evaluation was conducted in 14 sites.
1. BC PEWS is a valued and useful tool that has brought about positive changes in the care of pediatric patients.
2. With the implementation of PEWS, there has been substantive increase in documentation of physiological parameters.
3. Overall satisfaction of nurses and physicians was high.
4. Educational opportunities remain in some areas including: calculating PEWS scores, flowsheet and escalation aid usage.
Richmond Hospital Research Study: Piloting PEWS for Emergency Departments in BC: A mixed method research study was conducted at Richmond Hospital, a general hospital with an emergency department serving approximately 6800 pediatric patients per year (roughly 12% of all patient visits). Results were very positive overall and are helping to inform the implementation of BC PEWS ED.
1. There are cumulative benefits from the use of both CTAS and PEWS at triage.
2. Similar to the inpatient setting, there was a substantive increase in documentation of physiological parameters.
3. Pediatric knowledge and inter-team communication improved.
4. PEWS is a valued and useful tool in the ED.
5. Opportunities to improve use of situational awareness exist.
6. Some challenges with time pressure in ED and false positives in scoring were identified.
Using the Results of the Evaluation/Research
- CHBC is redesigning the PEWS flowsheet based on feedback received.
- A PEWS refresher course is being developed as an additional online education resource focused on common errors identified from the evaluation.
- BC PEWS ED is being implemented in emergency departments across BC.
What resources are available for education and implementation?
See below for the tools that have been created to support the implementation of BC PEWS and
BC PEWS ED.