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Description

Background: The inpatient pulmonary unit (D9) utilizes a modified pediatric early warning score (PEWS) to identify deteriorating patients. D9 emergency team activations and code event reviews found PEWS documentation discrepancies and inaccuracies. 66% of D9 nurses reported PEWS scores are inaccurate for the pulmonary population and this is a major barrier to using PEWS. The Iowa model was used to identify a different tool, compare psychometrics, and measure nurses’ perceptions to establish the best early warning tool for pediatric pulmonary patients.

Methods: Inclusion criteria was patients admitted to D9 with baseline tracheostomy, oxygen, or invasive/non-invasive ventilation. Literature review revealed no pre-existing pediatric pulmonary specific early warning tool. However, the Children’s hospital early warning score (CHEWS) tool is validated with 84% sensitivity and 81% specificity and utilizes patient’s baseline status; thus, practice change was recommended to use CHEWS. Nurses completed a CHEWS paper pilot form on patients who met inclusion criteria, these patients were the “control” group and did not experience deterioration events. Retrospective chart analysis was completed on all D9 deterioration events and ICU transfers for the past 18 months. CHEWS and PEWS scores at time of event and 4-6 hours prior to event were analyzed. Nursing perception survey of PEWS and CHEWS was obtained.

Results: The pilot results yielded 38 patient deterioration events and 47 control events. CHEWS score demonstrated 84% sensitivity and 89% specificity while PEWS sensitivity was 79% and specificity was 28% showing PEWS failed to be an accurate predictor of deterioration and ICU transfer. CHEWS pilot has now expanded across Children’s Health System of Texas, which will balance some of the initial pilot concerns of high census, high unit acuity, and small sample size. Additional sensitivity and specificity will be calculated from the larger group for validation, if validation is consistent with pilot then CHEWS tool will be implemented.

Publication Date

2021

Disciplines

Pediatric Nursing

Improving Patient Safety by Predicting Early Deterioration in thePediatric Pulmonary Population

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