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Pediatric Early Warning System (PEWS) A Provincial Approach

Pediatric Early Warning System (PEWS) A Provincial Approach. Who is Child Health BC?. A provincial network working collaboratively to build an integrated, accessible system of health services for children and youth. All 7 Health Authorities, including First Nations HA

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Pediatric Early Warning System (PEWS) A Provincial Approach

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  1. Pediatric Early Warning System (PEWS)A Provincial Approach

  2. Who is Child Health BC? A provincial network working collaboratively to build an integrated, accessible system of health services for children and youth. • All 7 Health Authorities, including First Nations HA • UBC Department of Pediatrics • The three child serving ministries (MoE, MCFD & MoH) • Research (Maternal Infant Child Youth Research Network) • BC Pediatric Society • Doctors of BC • Society of General Practitioners of BC

  3. What are we trying to achieve? Creation of a planned, rational system of health services for children & youth in BC.

  4. What is PEWS? • AN EVIDENCED-INFORMED CLINICAL TOOL • Identifies children as soon as possible, who are at risk of clinical deterioration. • Mitigates risk through clinical and procedural response • Provides escalation of care guidance • Provides a common language and communication framework to standardize care for children across the Province

  5. Why use a PEWS? Early recognition offers a window of opportunity to intervene for improved outcomes. Evidence indicates prevention is possible • ~63 to 89% of children do not survive cardiac arrest • Morbidity in survivors remains high despite advances • Pediatric patients may demonstrate symptom deterioration up to 24 hours prior to cardiopulmonary arrest

  6. A Case for Change • Used internationally for over 10 years • Identified as a high priority by Health Authorities. • Child Health BC has been working with BCCH and Health Authority Pediatric Planners to develop a PEWS system that will work across the province

  7. The Challenge 95-98% of adverse events are due to system failures1 • Healthcare is optimized when systems work seamlessly • This is achieved by empowering all members of the team to make the safest decision for every patient • The challenge is maintaining a strong network of care Improving the systems through which healthcare is delivered is fundamental to reducing clinical error

  8. The Solution Creating safety requires changing the conditions in which people work Pediatric Early WarningSystem

  9. Benefits of a Provincial Approach • Promotes a consistent standard of care for pediatric patients across BC • Utilizes expertise and resources efficiently to develop evidence informed standards • Provides a common language and benchmark for pediatric care • Facilitates safe transitions

  10. Purpose of PEWS • Identifypediatric patients who are at risk of deterioration • Mitigate the risk (through clinical and procedural response) • Escalateto a higher level of care if mitigation is unsuccessful … and do it all sooner!

  11. Components of the PEWS

  12. Common in the US, UK, Australia, Canada Many tools, most adapted from the Brighton tool Primarily used in pediatric and general inpatient units Some modification for emergency departments and cardiac units. Limited reported use in post operative recovery Where is PEWS used?

  13. PEWS Is: Is not: A substitute for clinical judgment A comprehensive clinical assessment tool An indicator for immediate admission to ICU A replacement for CTAS • A support to good clinical judgment • Red flag of potential/established critical illness • Generally sensitive depending upon its complexity • An aid to effective communication

  14. PEWS research has found… • Nearly 50% decrease in rates of UNSAFE ICU transfers • Potentially provides leeway time of >11 hours • Positive directional trends in improved clinical outcomes • Enhanced inter-disciplinary team work, communication and confidence • There are no negative outcomes reported in the literature related to the use of PEWS

  15. CHBC PEWS Implementation Plan Phase 1 Outputs • A literature review • A provincial standardized System which includes: • PEW Score imbedded in flow sheet, • Situational awareness bundle, • Communication framework (SBAR) and • Escalation protocol • An education strategy • An evaluation strategy

  16. CHBC PEWS Implementation Plan Phase 2 Outputs • Implementation in inpatient general and pediatric units at 14 sites in BC • Pilot in Emergency department and Pediatric Short Stay Unit at Richmond General Hospital • Provision of education at all 15 sites • Evaluation • Plan for spread

  17. Roles and Responsibilities CHBC HAs Support and collaborate Approve at HAMAC and Quality Build PEWS into ongoing operations Ensure clinical staff working with children maintain pediatric skills Develop site escalation protocols • Provide leadership and project management support • Support development of PEWS system incl. guidelines, protocols and provincial documentation • Support education of trainers, clinical staff and physicians • Support evaluation

  18. Thank you and Questions Who to contact forinformation? • Place contacts for your agency/health authority here.

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