How to implement a PEWS in a resource‐limited setting: A quantitative analysis of the bedside‐PEWS implementation in a hospital in northeast Brazil

Abstract

OBJECTIVES Quantitative analysis of the implementation of the bedside paediatric early warning system (B‐PEWS) in a resource‐limited setting. The B‐PEWS serves to pre‐emptively identify hospitalised children who are at risk for cardiopulmonary arrest and subsequently to provide critical care in time. METHODS We performed a retrospective review through the medical data records of patients after discharge from the paediatric ward of a philanthropic hospital in Brazil. Nurses’ performance using the system was measured with various parameters. RESULTS A total of 499 patients were included, and a total of 8024 scores were checked. During the 21‐week research period, the implementation rate increased significantly from 66.5% (SD 26.0) in Period 1 to 93.1% (SD 16.6) in Period 2. The number of scores that resulted in a correct total score went from 7.5% in Period 1 to 32.2% in Period 2, p < 0.001. There was an improvement in the correct choice of age group between the two periods (from 32.2% to 53.4%). There was no difference in the mean admission time of patients in the two periods: in the first period 4.8 days (SD 2.9) and in the second period 4.8 days (SD 4.1). CONCLUSIONS It is possible to implement a PEWS in resource‐limited settings while achieving high implementation rates. However, this is a time‐ and energy‐consuming process. Having an active and involved team that is responsible for implementation is key for a successful implementation. Factors that likely hindered implementation were a large change in workflow for the nursing staff, non‐native speakers as main investigators.

Development and an initial validation of the Responses to Illness Severity Quantification (RISQ) score for severely malnourished children

“…The potential benefit of newer multi‐modal devices, becoming increasingly more available in inpatient units in low‐resource settings, is their capacity for obtaining measurements, such as pulse rate and respiratory rates, that often prove challenging to obtain manually 16,17 . Our study, conducted in a highly volatile region of Africa known for humanitarian crises, as well as other studies in LMICs, illustrates that with training, measurements and implementation of scores are feasible 18,19 …”

Desempenho do Escore Pediátrico de Alerta (EPA) de deterioração clínica

“…No entanto, este é um processo que consome tempo e energia, e requer uma equipe ativa e envolvida para o sucesso da implementação. (33) Escores pediátricos de alerta têm sido destacados pelo seu desempenho no reconhecimento precoce da piora clínica, já que fornecem evidências quantificáveis da deterioração. Porém, é importante destacar que os PEWS não irão identificar todas as crianças em risco de piora clínica, seja pela velocidade ou pelo mecanismo envolvido na deterioração, sendo essencial o treinamento da equipe para reconhecer padrões comuns de deterioração e não confiar no PEWS como único mecanismo de rastreio.…”

Impact of hospital characteristics on implementation of a Pediatric Early Warning System in resource-limited cancer hospitals

“…PEWS produce multi-level advantages beyond the patient ( 14 ), such as improving interdisciplinary ( 15 ) and family communication ( 16 ), reducing hospital costs ( 17 ), and empowering providers ( 18 ). Resource-limited hospitals, however, face additional challenges implementing PEWS ( 19 ). More work is needed to understand how to address implementation challenges and support PEWS adoption in these settings.…”

“…Pediatric Early Warning Systems (PEWS) are evidence-based interventions that allow for early detection of clinical deterioration in hospitalized children with cancer (11)(12)(13). PEWS produce multilevel advantages beyond the patient (14), such as improving interdisciplinary (15) and family communication (16), reducing hospital costs (17), and empowering providers (18). Resource-limited hospitals, however, face additional challenges implementing PEWS (19).…”