P2D250: Pediatric Early Warning Systems: A Multidisciplinary Quality Improvement Policy

Purpose/Objectives: Pediatric Early Warning Systems (PEWS) is a scoring system aimed at increasing efficiency of care delivery to critically ill children who are at high risk of deterioration (Duncan, 2006). At our institution, the decompensation of a seriously ill child led to the review and revision of the current PEWS policy. Inconsistencies in the utilization of PEWS were identified, and a multidisciplinary team was developed to improve the implementation and education surrounding this scoring system.
In October 2021, we set out to improve compliance of our PEWS process from 80% to >95% within 6 months.

Design/Methods: This was conducted as a prospective single-center cohort quality improvement project. We began with identification of key stakeholders including attending physicians, resident physicians, nurse managers, clinical nurse specialists, clinical logistics specialists and the hospital quality and safety department. This group met for the first time in October 2021 to review baseline data and create a plan utilizing a driver diagram to target multiple aspects of this improvement effort. This group subsequently reviewed current policies surrounding PEWS. Findings from these reviews led to several interventions and the conduction of several Plan-Do-Study-Act (PDSA) cycles aimed at increasing compliance with our PEWS policies.

Our multidisciplinary committee ultimately rewrote the PEWS policy in our hospital. We had several lectures centered around resident and nursing education regarding the changes made to the policy. We also reconfigured the Rapid Response Team to include a provider from the PICU. Finally, we conducted a debrief with the RRT following each rapid response to assess for areas of improvement.

Results: Baseline review of current state of PEWS in October 2021 demonstrated a compliance rate of 82.13%. On average, one rapid response was called every 10 days. A code blue was called roughly every 25 days. After 6 months, we demonstrated a compliance of 86.25%. However, a Rapid Response was called roughly every 2 days and no code blues were called in the final three months of our tracking period.

Conclusion/Discussion: PEWS remains an effective tool in maintaining high-quality patient care. Shared efforts within the multidisciplinary team allowed for the successful change in culture required to appropriately utilize this tool. While a PEWS score is calculated by the bedside nursing staff, educating all members of the healthcare staff in the use of PEWS allowed for the creation of a shared mental model and improvement in patient safety. The score also empowered frontline staff to escalate concerns, and allowed members of the healthcare team not present at the bedside to participate in care. While we ultimately did not meet our compliance goal, the clear decrease in code blue events showed our healthcare teams were able to identify critically ill children and intervene before a potentially life threatening decompensation.