25 - Improving Patient Safety and Surveillance through Accurate PEWS Reporting

Poster Number: 25
Publication Number: 25.3226

Background: The Pediatric Early Warning Score (PEWS) is a validated, objective tool used as an adjunctive assessment to detect early signs of patient deterioration. The PEWS is inherently more complex than Modified Early Warning Scores (MEWS) due to age-based variations in behavior and normative vital signs. Thus, PEWS is more prone to error by the end-user, which we identified through qualitative feedback and auditing of previous quality projects.

Objective: The objective of this project was to improve the accuracy of PEWS scoring, potentially decreasing the need for Pediatric Intensive Care Unit (PICU) transfer or initiation of Rapid Response Team (RRT) calls.

Design/Methods: A children’s hospital’s multidisciplinary collaborative group of nursing, physician, information technology, and quality leaders planned and collected quality data during multiple PDSA cycles. Interventions from February 2012 through August 2023 included knowledge surveys, traditional education, interactive simulation education, EMR enhancements, policy change, and electronic tool redesign. Traditional run charts were employed to plot the rates of accuracy of PEWS scoring based on inter-rater reliability via audits over time and through PDSA cycles in the acute inpatient units (AIP) and pediatric emergency department (PED).

Results: During the study period, the mean accurate completion rate of PEWS increased on AIP from 77.1% to 87.6%. Within the last 4 months of the study period, following the final intervention, we observed mean accuracy >92%. The mean accurate completion rate of PED PEWS increased from 53.2% to 76.8%. During the project, our AIP RRT rate decreased from 23/1000 inpatient days to 14.9/1000 inpatient days, (-35%). Additionally, the bounce-up rate, upgrading from AIP to PICU within 6 hours of admission from the PED, decreased from 1.29/100 admitted PED patients to 0.39/100, (-73%).

Conclusion(s): Accurate PEWS for admitted PED and AIP patients may lead to earlier interventions and prevent the need to transfer patients to a higher level of care. Electronic tool redesign, including some automation of the scoring system was crucial in facilitating end-user accuracy. Developers of EMR-based documentation tools requiring accuracy and timeliness must consider nursing workflow needs and ease-of-use to enhance value and promote patient safety.