news views Summer 2013
A Publication of the Department of Nursing and Patient Care Services
University of Maryland Medical Center
Implementation of the Pediatric Early Warning Score (PEWS) at UMMC Diana Novak, MS, RN, CCRN, Pediatric ICU, Lisa Sliva, BSN , RN, CPN, Acute Care Pediatrics and Jessica Strohm-Farber, DNP, CRNP, Pediatric ICU
A code-blue event on the pediatric acute care unit is a rare occurrence, but when it happens, the stakes are high. Such events outside of the intensive care unit are uncommon, but all hospitalized pediatric patients are at risk for sudden deterioration. The chances of survival after pediatric cardiac arrest are poor, with survival rates reported between 15 to 36%.1 Rapid response teams (RRT) and early warning scores (EWS) are two systems that can potentially improve these outcomes. While RRTs effectively bring critical care experience to the patient’s bedside, the teams are often called too late.2 The use of the Pediatric Early Warning Score (PEWS) can provide the earlier identification and intervention needed to improve patient outcomes. PEWS is an objective scoring tool based on the patient’s behavior, cardiovascular status, and respiratory status.3 The tool helps to “package” the patient’s physiological data and clearly identifies the patient’s deteriorating status. The “packaging” effect of early warning scores empowers nurses with one study reporting an 80% increase in nursing confidence.4
Pediatric Nursing Team Implements PEWS on Acute Care Unit
Early warning scores, such as PEWS, also improve communication between members of the care team, providing a concise, objective, and standardized means of communicating concern about a patient. Improved communication is significant to
patient outcomes since communication failure is the root cause of more than 60% of sentinel events reported to The Joint Commission.5, 6, 7 PEWS has been shown to identify patients with at least an hour’s warning prior to a code-blue event. One study demonstrated greater than 11 hours forewarning time.8, 9, 10 The situational awareness created by using PEWS reduces unrecognized deterioration of patients, allowing for earlier identification of deterioration, escalation to a higher level of care, and earlier intervention, ultimately leading to improvement in patient outcomes.11 In February of this year, an interdisciplinary workgroup was created by UMMC pediatric providers in order to implement PEWS within the University of Maryland Children’s Hospital. The goal of PEWS implementation is to identify the potential for patient deterioration; with the objective of early identification of evolving critical illness and reduction of code-blue events within the pediatric population. Prior to the initiation of the workgroup, a PEWS feasibility study was completed to determine the appropriateness of PEWS for the UMMC inpatient pediatric population and to determine PEWS thresholds for the continued on page 4.
Lisa Rowen’s Rounds: Becoming a High Reliability Organization Whether we travel in an airplane, ride on a roller coaster or live near a nuclear reactor site, we expect the experience will be safe and consistently reliable. If you were told your air travel or roller coaster ride would be safe 90% of the time, how would you feel? Would that be good enough? How would you feel Lisa Rowen, DNSc, RN, FAAN, if a nuclear reactor site within miles of your home Senior Vice President and announced its safety system could be counted on Chief Nursing Officer, Nursing and Patient Care Services 93% of the time? Would you be impressed? I’m going to guess that no, you would not be impressed. In fact, if I were told these statistics, I’d
opt not to ride an airplane or a roller coaster, and I would not buy a home near the nuclear reactor site. These odds are just not good enough. Every time a patient enters a hospital, he or she expects the experience to be safe and highly reliable. Patients expect their lab work and diagnostic testing to be performed correctly and assessed in a timely and accurate manner. They assume they will receive the correct care or procedure ordered by their provider. They believe the blood products and medications continued on page 16.