Implementing paediatric early warning scores systems in the Netherlands: future implications

Abstract

BackgroundPaediatric Early Warning Scores (PEWS) are increasingly being used for early identification and management of clinical deterioration in paediatric patients. A PEWS system includes scores, cut-off points and appropriate early intervention. In 2011, The Dutch Ministry of Health advised hospitals to implement a PEWS system in order to improve patient safety in paediatric wards. The objective of this study was to examine the results of implementation of PEWS systems and to gain insight into the attitudes of professionals towards using a PEWS system in Dutch non-university hospitals.MethodsQuantitative data were gathered at start, midway and at the end of the implementation period through retrospective patient record review (n = 554). Semi-structured interviews with professionals (n = 8) were used to gain insight in the implementation process and experiences. The interviews were transcribed and analysed using an inductive approach.ResultsLooking at PEWS systems of the five participating hospitals, different parameters and policies were found. While all hospitals included heart rate and respiratory rate, other variables differed among hospitals. At baseline, none of the hospitals used a PEWS system. After 1 year, PEWS were recorded in 69.2% of the patient records and elevated PEWS resulted in appropriate action in 49.1%. Three themes emerged from the interviews: 1) while the importance of using a PEWS system was acknowledged, professionals voiced some doubts about the effectiveness and validity of their PEWS system 2) registering PEWS required little extra effort and was facilitated by PEWS being integrated into the electronic patient record 3) Without a national PEWS system or guidelines, hospitals found it difficult to identify a suitable PEWS system for their setting. Existing systems were not always considered applicable in a non-university setting.ConclusionsAfter 1 year, hospitals showed improvements in the use of their PEWS system, although some were decidedly more successful than others. Doubts among staff about validity, effectiveness and communication with other hospitals during transfer to higher level care hospital might hinder sustainable implementation. For these purposes the development of a national PEWS system is recommended, consisting of a “core set” of PEWS, cut-off points and associated early intervention.

Missed opportunities: incomplete and inaccurate recording of paediatric early warning scores

“…More erroneous scores were underscored, rather than overscored. We have no indication that the practice in our organisation differs significantly from other similar centres, and incidental findings from other studies would support this assertion 10 18…”

“…A recent randomised controlled trial found less than 5% of observation sets had all the required clinical observations for the PEWS 10. A further study found only 69.2% of patient records had a score recorded 1 year after implementation 18. Marked differences in completeness were seen between hospitals with paper-based charts (28.8%) and electronic documentation systems (95.2%).…”

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

“…Earlier research shows that the success of implementing clinical guidelines and systems can depend greatly on how much the new practitioner workflow differs from the prior workflow [ 12 , 19 ]. The results from this study comply with these findings, as the implementation rate in the paediatric ward drastically improved after adjusting it to resemble the previous manner of monitoring the patients more closely.…”

“…There are numerous validated PEWS with varying accuracy in predicting deterioration [ 2 , 9 , 10 , 11 ]. The validation and research on PEWS are mostly done in high‐resource settings [ 2 , 4 , 9 , 10 , 11 , 12 ], while the literature on PEWS in resource‐limited settings is scarce [ 13 ]. Implementing PEWS in high‐resource settings has not shown to result in significant reduction in child mortality, presumably because the baseline mortality is too low to measure the impact of a PEWS, but it results in better child attention [ 14 , 15 ].…”

Modern View on the Role of Epidermal Barrier in Atopic Phenotype Development in Children

“…В других небольших исследованиях, выполненных в экономически менее благополучных странах, напротив, отмечено положительное влияние внедрения системы раннего предупреждения на эффективность лечения детей в виде снижения частоты неблагоприятных инцидентов в стационарах и снижения частоты летальных исходов от них [12,13], снижения частоты осложнений на догоспитальном этапе оказания медицинской помощи [14]. Отмечено улучшение коммуникации между врачебным персоналом медицинских организаций различного уровня через 1 год после внедрения системы раннего предупреждения за счет единообразной оценки и трактовки полученных результатов [15].…”