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;
Childrens 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 patients 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, its time to call a
physician. Patients also have a cumulative score, ranging
from zero to 11, 11 being the worst possible score, but its
more important to watch the trending of the score using
the baseline. An accompanying algorithm clearly indicates
what clinical staff should do next, whether its notify the
physician, Respiratory department or a Rapid Response
Team, or transfer the patient to the ICU.
To simplify assessment and tracking, Childrens 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 Childrens at Egleston and
2 West at Childrens 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 couldnt 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.