pack to pilot the PEWS approach to establish a baseline for

a patient coming from an intensive care unit, an emergency

department or surgical services to a general care unit;

Children’s will implement PEWS in all three areas.

Once they establish a baseline, caregivers will assess the

patient in four categories: behavior, cardiovascular status,

respiratory status and interventions. It is important to

score for frequent interventions that are used to maintain

a patient’s stability (i.e., suctioning, repositioning, multiple

IV attempts), because these interventions are all attempts at

preventing deterioration and are indicators that the patient

is beginning to decline.

Patients receive a score from zero to three in each category.

If a child scores a three in any category, it’s time to call a

physician. Patients also have a cumulative score, ranging

from zero to 11, 11 being the worst possible score, but it’s

more important to watch the trending of the score using

the baseline. An accompanying algorithm clearly indicates

what clinical staff should do next, whether it’s notify the

physician, Respiratory department or a Rapid Response

Team, or transfer the patient to the ICU.

To simplify assessment and tracking, Children’s has already

added PEWS to Epic. Another benefit of the electronic tool

is the ability to measure the acuity of patients by unit or

department and bring resources to those staff and patients if

the PEWS numbers are increasing on a floor.

The Cardiac Step Down unit at Children’s at Egleston and

2 West at Children’s at Scottish Rite are piloting the program

with plans to go-live Systemwide in November.

“If we can identify and prevent a patient from failing six

to eight hours before it happens, it will transform pediatric

care,” said Christiane Levine, Senior Process Improvement

Consultant. “What we learned from studying PEWS is that

children give us the same window of warning as adults, but

we couldn’t always put the signs together. We now have

facts to support the gut feeling that something is wrong.”

SEPTEMBER/OCTOBER 15

Pediatric Early Warning Score Card

Behavior • lethargic, confused, or • Reduced pain response

Cardiovascular

Respiratory

3

• Grey or • CRT ≥5 or• Tachycardia 30 above or• Bradycardia for age

Score*

2 1 0

• 5 below normal with retractions and/or • ≥50% Fi02

• Irritable or agitated and not consolable

• CRT 4 seconds or• Tachycardia of 20 above normal parameters

• >20 above normal• using accessory muscles or• 40%-49% Fi02 or• ≥3 lPM

• Sleeping or• Irritable and consolable

• Pale or• CRT 3 seconds

• >10 above normal• using accessory muscles or • 24-40% Fi02 or ≥2 lPM• Any initiation of 02

• Playing• Appropriate for patient

• Pink, CRT 1-2 seconds

• WNl for age• No retractions

** Parental concern should be an automatic call to the Rapid Response Team.

TOTAL

* Add 2 points for frequent interventions (suction, positioning, 02 changes) or multiple IV attempts.

Score ≥ 7 Assmt. every 30 mins. • Score 6 Assmt. every 1 hour. • Score 5 Assmt. every 1-2 hours. • Score 0-4 Assmt. every 4 hours.