the irish paediatric early warning system · the irish paediatric early warning system ... pews...
TRANSCRIPT
![Page 1: The Irish Paediatric Early Warning System · The Irish Paediatric Early Warning System ... PEWS Lifebuoy •Need to be ... In Conclusion •The Irish PEWS is more than a score](https://reader030.vdocument.in/reader030/viewer/2022020412/5acd0b837f8b9aa1518cff14/html5/thumbnails/1.jpg)
The Irish Paediatric Early Warning System
Rachel MacDonell, National PEWS Coordinator
PEWS
![Page 2: The Irish Paediatric Early Warning System · The Irish Paediatric Early Warning System ... PEWS Lifebuoy •Need to be ... In Conclusion •The Irish PEWS is more than a score](https://reader030.vdocument.in/reader030/viewer/2022020412/5acd0b837f8b9aa1518cff14/html5/thumbnails/2.jpg)
PEWS Paediatric Early Warning Score
![Page 3: The Irish Paediatric Early Warning System · The Irish Paediatric Early Warning System ... PEWS Lifebuoy •Need to be ... In Conclusion •The Irish PEWS is more than a score](https://reader030.vdocument.in/reader030/viewer/2022020412/5acd0b837f8b9aa1518cff14/html5/thumbnails/3.jpg)
PEWS Paediatric Early Warning Score System
![Page 4: The Irish Paediatric Early Warning System · The Irish Paediatric Early Warning System ... PEWS Lifebuoy •Need to be ... In Conclusion •The Irish PEWS is more than a score](https://reader030.vdocument.in/reader030/viewer/2022020412/5acd0b837f8b9aa1518cff14/html5/thumbnails/4.jpg)
![Page 5: The Irish Paediatric Early Warning System · The Irish Paediatric Early Warning System ... PEWS Lifebuoy •Need to be ... In Conclusion •The Irish PEWS is more than a score](https://reader030.vdocument.in/reader030/viewer/2022020412/5acd0b837f8b9aa1518cff14/html5/thumbnails/5.jpg)
![Page 6: The Irish Paediatric Early Warning System · The Irish Paediatric Early Warning System ... PEWS Lifebuoy •Need to be ... In Conclusion •The Irish PEWS is more than a score](https://reader030.vdocument.in/reader030/viewer/2022020412/5acd0b837f8b9aa1518cff14/html5/thumbnails/6.jpg)
PEWS Project Plan
Design
• Project team
• Detection & Response system
• Education
Test • Can it work?
• Findings from review
Pilot • Does it work?
• Why does it work?
Spread
Evaluate
Train the trainers
Does it improve care?
![Page 7: The Irish Paediatric Early Warning System · The Irish Paediatric Early Warning System ... PEWS Lifebuoy •Need to be ... In Conclusion •The Irish PEWS is more than a score](https://reader030.vdocument.in/reader030/viewer/2022020412/5acd0b837f8b9aa1518cff14/html5/thumbnails/7.jpg)
Irish PEWS …2014
• Jan Project initiated
• Feb Working Group Established
• April International PEWS tool review
• Aug PEWS literature review
• Sept PEWS co-ordinator, charts Version 1
• Nov Version 5, Compass adapted
• Dec Train the trainer, site visits
![Page 8: The Irish Paediatric Early Warning System · The Irish Paediatric Early Warning System ... PEWS Lifebuoy •Need to be ... In Conclusion •The Irish PEWS is more than a score](https://reader030.vdocument.in/reader030/viewer/2022020412/5acd0b837f8b9aa1518cff14/html5/thumbnails/8.jpg)
Irish PEWS …2015
• Feb Pilot launch- Version P7
• Mar Pilot complete, audits/ focus groups
• April Revision of parameters
• May Retesting - Version P13
• June Roll out to pilot sites
• July Compass ‘PEWS Education’
• Sept Version N2
• Nov NCG No. 12 PEWS
![Page 9: The Irish Paediatric Early Warning System · The Irish Paediatric Early Warning System ... PEWS Lifebuoy •Need to be ... In Conclusion •The Irish PEWS is more than a score](https://reader030.vdocument.in/reader030/viewer/2022020412/5acd0b837f8b9aa1518cff14/html5/thumbnails/9.jpg)
Design
![Page 10: The Irish Paediatric Early Warning System · The Irish Paediatric Early Warning System ... PEWS Lifebuoy •Need to be ... In Conclusion •The Irish PEWS is more than a score](https://reader030.vdocument.in/reader030/viewer/2022020412/5acd0b837f8b9aa1518cff14/html5/thumbnails/10.jpg)
Design
“positive directional trends in improving clinical based outcomes” “there is no consensus and limited evidence about which PEW system is most useful or ‘optimal’ for paediatric contexts”
![Page 11: The Irish Paediatric Early Warning System · The Irish Paediatric Early Warning System ... PEWS Lifebuoy •Need to be ... In Conclusion •The Irish PEWS is more than a score](https://reader030.vdocument.in/reader030/viewer/2022020412/5acd0b837f8b9aa1518cff14/html5/thumbnails/11.jpg)
Test
Pilot
![Page 12: The Irish Paediatric Early Warning System · The Irish Paediatric Early Warning System ... PEWS Lifebuoy •Need to be ... In Conclusion •The Irish PEWS is more than a score](https://reader030.vdocument.in/reader030/viewer/2022020412/5acd0b837f8b9aa1518cff14/html5/thumbnails/12.jpg)
Pilot
• 4 sites, 7 wards
• Audit
– Compliance
– Amendments
– Training evaluations
– Staff feedback
– Focus groups
![Page 13: The Irish Paediatric Early Warning System · The Irish Paediatric Early Warning System ... PEWS Lifebuoy •Need to be ... In Conclusion •The Irish PEWS is more than a score](https://reader030.vdocument.in/reader030/viewer/2022020412/5acd0b837f8b9aa1518cff14/html5/thumbnails/13.jpg)
Pilot learning “I think everybody is liking the tool and liking the structure around reporting and who to go to and what to do when something isn't just quite right” (FG3)
“We are seeing children when we should be seeing them early on in illness” (FG3)
“Delegation is easier and maybe the more qualified can look after the sicker patient if necessary” (FG4)
“I think what it has done is given us a more structured way of being consistent in how we communicate” (FG2)
“The consensus from the ward seems to be very positive and the feedback from the staff from the very first day has been very positive” (FG1)
![Page 14: The Irish Paediatric Early Warning System · The Irish Paediatric Early Warning System ... PEWS Lifebuoy •Need to be ... In Conclusion •The Irish PEWS is more than a score](https://reader030.vdocument.in/reader030/viewer/2022020412/5acd0b837f8b9aa1518cff14/html5/thumbnails/14.jpg)
P13 N2
![Page 15: The Irish Paediatric Early Warning System · The Irish Paediatric Early Warning System ... PEWS Lifebuoy •Need to be ... In Conclusion •The Irish PEWS is more than a score](https://reader030.vdocument.in/reader030/viewer/2022020412/5acd0b837f8b9aa1518cff14/html5/thumbnails/15.jpg)
PEW System
Observations abnormal
Observations normal
No concern Concern
![Page 16: The Irish Paediatric Early Warning System · The Irish Paediatric Early Warning System ... PEWS Lifebuoy •Need to be ... In Conclusion •The Irish PEWS is more than a score](https://reader030.vdocument.in/reader030/viewer/2022020412/5acd0b837f8b9aa1518cff14/html5/thumbnails/16.jpg)
PEWS is not…
• Replacement for
– Calling the emergency team in the event of collapse with suspected cardiac or respiratory arrest
– Contacting medical personnel for immediate review of any patient about whom there is clinical concern
![Page 17: The Irish Paediatric Early Warning System · The Irish Paediatric Early Warning System ... PEWS Lifebuoy •Need to be ... In Conclusion •The Irish PEWS is more than a score](https://reader030.vdocument.in/reader030/viewer/2022020412/5acd0b837f8b9aa1518cff14/html5/thumbnails/17.jpg)
Core Observations
1 Nurse or family concerns 0,1,
2 Respiratory Rate 0,1,2,3
3 Respiratory Effort 0,1,3
4 Oxygen therapy (mode + pressure) 0,1,2 + 0,1
5 Heart Rate 0,1,2,3
6 AVPU 0,1,3
Additional observations if clinically required
7 SpO2 0,1,2,3
8 Capillary refill time (central) 0,1
9 Blood Pressure (systolic) 0,1,2,3
10 Skin colour No score
11 Temperature No score
Triggers
![Page 18: The Irish Paediatric Early Warning System · The Irish Paediatric Early Warning System ... PEWS Lifebuoy •Need to be ... In Conclusion •The Irish PEWS is more than a score](https://reader030.vdocument.in/reader030/viewer/2022020412/5acd0b837f8b9aa1518cff14/html5/thumbnails/18.jpg)
PEWS charts
![Page 19: The Irish Paediatric Early Warning System · The Irish Paediatric Early Warning System ... PEWS Lifebuoy •Need to be ... In Conclusion •The Irish PEWS is more than a score](https://reader030.vdocument.in/reader030/viewer/2022020412/5acd0b837f8b9aa1518cff14/html5/thumbnails/19.jpg)
![Page 20: The Irish Paediatric Early Warning System · The Irish Paediatric Early Warning System ... PEWS Lifebuoy •Need to be ... In Conclusion •The Irish PEWS is more than a score](https://reader030.vdocument.in/reader030/viewer/2022020412/5acd0b837f8b9aa1518cff14/html5/thumbnails/20.jpg)
Standardised education
![Page 21: The Irish Paediatric Early Warning System · The Irish Paediatric Early Warning System ... PEWS Lifebuoy •Need to be ... In Conclusion •The Irish PEWS is more than a score](https://reader030.vdocument.in/reader030/viewer/2022020412/5acd0b837f8b9aa1518cff14/html5/thumbnails/21.jpg)
Standardised observations
• A
• B
• C
• D
• E
![Page 22: The Irish Paediatric Early Warning System · The Irish Paediatric Early Warning System ... PEWS Lifebuoy •Need to be ... In Conclusion •The Irish PEWS is more than a score](https://reader030.vdocument.in/reader030/viewer/2022020412/5acd0b837f8b9aa1518cff14/html5/thumbnails/22.jpg)
PEWS does not replace an emergency call
Score Observation
Frequency Minimum Alert Minimum Response
1 4 hourly Nurse in Charge
Any trigger should prompt increase
in observation frequency as
clinically appropriate 2 2-4 hourly
3* 1 hourly Nurse in Charge + 1st on-call
Nurse in charge review
4-5 30 minutes Urgent medical review
6
Continuous
Nurse in Charge + 1st on-call
+ Senior Dr. + Consultant Urgent SENIOR medical review
≥7 URGENT PEWS CALL Immediate local response team
PEWS does not replace clinical concern
Standardised Escalation
![Page 23: The Irish Paediatric Early Warning System · The Irish Paediatric Early Warning System ... PEWS Lifebuoy •Need to be ... In Conclusion •The Irish PEWS is more than a score](https://reader030.vdocument.in/reader030/viewer/2022020412/5acd0b837f8b9aa1518cff14/html5/thumbnails/23.jpg)
Standardised communication
Identify
Situation
Background
Assessment
Recommendations
![Page 24: The Irish Paediatric Early Warning System · The Irish Paediatric Early Warning System ... PEWS Lifebuoy •Need to be ... In Conclusion •The Irish PEWS is more than a score](https://reader030.vdocument.in/reader030/viewer/2022020412/5acd0b837f8b9aa1518cff14/html5/thumbnails/24.jpg)
Standardised approach to sepsis
Paediatric Sepsis 6
Take 3 Give 3 • IV or IO access and take bloods - Blood Culture & PCR - FBC - Glucose & treat if low - Blood Gas - Lactate • Urine output measure
• Early Senior input
• High flow Oxygen • IV fluids - Aim to restore circulating volume - Titrate 20mls/kg isotonic fluid over 5-10 mins. - Consider early innotropes - Caution for fluid overload or hepatomegaly • Broad spectrum IV Antibiotics
![Page 25: The Irish Paediatric Early Warning System · The Irish Paediatric Early Warning System ... PEWS Lifebuoy •Need to be ... In Conclusion •The Irish PEWS is more than a score](https://reader030.vdocument.in/reader030/viewer/2022020412/5acd0b837f8b9aa1518cff14/html5/thumbnails/25.jpg)
Standardised documentation
![Page 26: The Irish Paediatric Early Warning System · The Irish Paediatric Early Warning System ... PEWS Lifebuoy •Need to be ... In Conclusion •The Irish PEWS is more than a score](https://reader030.vdocument.in/reader030/viewer/2022020412/5acd0b837f8b9aa1518cff14/html5/thumbnails/26.jpg)
Parental engagement
What are your clinical concerns or worries? How can we help?
![Page 27: The Irish Paediatric Early Warning System · The Irish Paediatric Early Warning System ... PEWS Lifebuoy •Need to be ... In Conclusion •The Irish PEWS is more than a score](https://reader030.vdocument.in/reader030/viewer/2022020412/5acd0b837f8b9aa1518cff14/html5/thumbnails/27.jpg)
PEWS N2...............N3 (draft)
![Page 28: The Irish Paediatric Early Warning System · The Irish Paediatric Early Warning System ... PEWS Lifebuoy •Need to be ... In Conclusion •The Irish PEWS is more than a score](https://reader030.vdocument.in/reader030/viewer/2022020412/5acd0b837f8b9aa1518cff14/html5/thumbnails/28.jpg)
Paediatric Early Warning System
Team work & Communication
Clear Escalation Guide
ISBAR
Decision aides
Cardiovascular Prompts
Paediatric Sepsis 6
Situation Awareness “It’s more than the score”
“What’s going on & what’s going to happen”
Family Involvement “Are you concerned?”
PEWS observation
chart & score
![Page 29: The Irish Paediatric Early Warning System · The Irish Paediatric Early Warning System ... PEWS Lifebuoy •Need to be ... In Conclusion •The Irish PEWS is more than a score](https://reader030.vdocument.in/reader030/viewer/2022020412/5acd0b837f8b9aa1518cff14/html5/thumbnails/29.jpg)
PEWS Toolkit
• Many tools needed for even a small job
• Need to know how to use each tool
• Sometimes other experts are required
![Page 30: The Irish Paediatric Early Warning System · The Irish Paediatric Early Warning System ... PEWS Lifebuoy •Need to be ... In Conclusion •The Irish PEWS is more than a score](https://reader030.vdocument.in/reader030/viewer/2022020412/5acd0b837f8b9aa1518cff14/html5/thumbnails/30.jpg)
PEWS Lifebuoy
• Need to be spotted
• Need to tell right person
• Right response
PEWS
![Page 31: The Irish Paediatric Early Warning System · The Irish Paediatric Early Warning System ... PEWS Lifebuoy •Need to be ... In Conclusion •The Irish PEWS is more than a score](https://reader030.vdocument.in/reader030/viewer/2022020412/5acd0b837f8b9aa1518cff14/html5/thumbnails/31.jpg)
Governance & Leadership
Teamwork & Communicati
on
Situation Awareness
Family Involvement
Decision Aides
Ability to Respond
PEWS Scoring
Tool
![Page 32: The Irish Paediatric Early Warning System · The Irish Paediatric Early Warning System ... PEWS Lifebuoy •Need to be ... In Conclusion •The Irish PEWS is more than a score](https://reader030.vdocument.in/reader030/viewer/2022020412/5acd0b837f8b9aa1518cff14/html5/thumbnails/32.jpg)
Spread
![Page 33: The Irish Paediatric Early Warning System · The Irish Paediatric Early Warning System ... PEWS Lifebuoy •Need to be ... In Conclusion •The Irish PEWS is more than a score](https://reader030.vdocument.in/reader030/viewer/2022020412/5acd0b837f8b9aa1518cff14/html5/thumbnails/33.jpg)
Quality Framework
Quality
Leadership for quality
Engaging patients
Enabling staff
Systematic approach
Measure and learn
Governance
![Page 34: The Irish Paediatric Early Warning System · The Irish Paediatric Early Warning System ... PEWS Lifebuoy •Need to be ... In Conclusion •The Irish PEWS is more than a score](https://reader030.vdocument.in/reader030/viewer/2022020412/5acd0b837f8b9aa1518cff14/html5/thumbnails/34.jpg)
Quality Framework
PEWS
Leadership for quality
Engaging patients
Enabling staff
Systematic approach
Measure and learn
Governance
![Page 35: The Irish Paediatric Early Warning System · The Irish Paediatric Early Warning System ... PEWS Lifebuoy •Need to be ... In Conclusion •The Irish PEWS is more than a score](https://reader030.vdocument.in/reader030/viewer/2022020412/5acd0b837f8b9aa1518cff14/html5/thumbnails/35.jpg)
Central support
• Briefing meeting
• Train the Trainer x2
• Audit meeting x1
• Site visit as required/conference calls
• Post implementation visit
Hospital Group links to share learning and resources
![Page 36: The Irish Paediatric Early Warning System · The Irish Paediatric Early Warning System ... PEWS Lifebuoy •Need to be ... In Conclusion •The Irish PEWS is more than a score](https://reader030.vdocument.in/reader030/viewer/2022020412/5acd0b837f8b9aa1518cff14/html5/thumbnails/36.jpg)
PEWS package
• NCG No. 12, Implementation & Education guides
• National chart templates
• Manual
• Slide set x2
• Attendance/evaluation/certificate
• Quiz
• Case studies
• Ward resources (parent leaflet, quick reference guide, escalation poster, sepsis 6 poster)
• Audit tools
![Page 37: The Irish Paediatric Early Warning System · The Irish Paediatric Early Warning System ... PEWS Lifebuoy •Need to be ... In Conclusion •The Irish PEWS is more than a score](https://reader030.vdocument.in/reader030/viewer/2022020412/5acd0b837f8b9aa1518cff14/html5/thumbnails/37.jpg)
Evaluate
![Page 38: The Irish Paediatric Early Warning System · The Irish Paediatric Early Warning System ... PEWS Lifebuoy •Need to be ... In Conclusion •The Irish PEWS is more than a score](https://reader030.vdocument.in/reader030/viewer/2022020412/5acd0b837f8b9aa1518cff14/html5/thumbnails/38.jpg)
Evaluation
• Compliance
• Response
• Variance use
• Outcomes
• Satisfaction
• Safety culture
• Metrics/KPI
• HSE/HIQA
![Page 39: The Irish Paediatric Early Warning System · The Irish Paediatric Early Warning System ... PEWS Lifebuoy •Need to be ... In Conclusion •The Irish PEWS is more than a score](https://reader030.vdocument.in/reader030/viewer/2022020412/5acd0b837f8b9aa1518cff14/html5/thumbnails/39.jpg)
In Conclusion
• The Irish PEWS is more than a score
• The detection of sick or deteriorating children is best aided by a system of observations, conversations, projections & interventions focused on the child
• PEWS encourages & supports behaviours that promote patient safety