scholarly journals Adherence to the bedside paediatric early warning system (BedsidePEWS) in a pediatric tertiary care hospital

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Orsola Gawronski ◽  
Federico Ferro ◽  
Corrado Cecchetti ◽  
Marta Ciofi Degli Atti ◽  
Immacolata Dall’Oglio ◽  
...  
Keyword(s):  
Early Warning ◽  
Early Warning System ◽  
Tertiary Care ◽  
Vital Signs ◽  
Warning System ◽  
Hospital Inpatient ◽  
Care Hospital ◽  
Clinical Records ◽  
Hospital Wards ◽  
Score Range

Abstract Background The aim of this study is to describe the adherence to the Bedside Pediatric Early Warning System (BedsidePEWS) escalation protocol in children admitted to hospital wards in a large tertiary care children’s hospital in Italy. Methods This is a retrospective observational chart review. Data on the frequency and accuracy of BedsidePEWS score calculations, escalation of patient observations, monitoring and medical reviews were recorded. Two research nurses performed weekly visits to the hospital wards to collect data on BedsidePEWS scores, medical reviews, type of monitoring and vital signs recorded. Data were described through means or medians according to the distribution. Inferences were calculated either with Chi-square, Student’s t test or Wilcoxon-Mann–Whitney test, as appropriate (P < 0.05 considered as significant). Results A total of 522 Vital Signs (VS) and score calculations [BedsidePEWS documentation events, (DE)] on 177 patient clinical records were observed from 13 hospital inpatient wards. Frequency of BedsidePEWS DE occurred < 3 times per day in 33 % of the observations. Adherence to the BedsidePEWS documentation frequency according to the hospital protocol was observed in 54 % of all patients; in children with chronic health conditions (CHC) it was significantly lower than children admitted for acute medical conditions (47 % vs. 69 %, P = 0.006). The BedsidePEWS score was correctly calculated and documented in 84 % of the BedsidePEWS DE. Patients in a 0–2 BedsidePEWS score range were all reviewed at least once a day by a physician. Only 50 % of the patients in the 5–6 score range were reviewed within 4 h and 42 % of the patients with a score ≥ 7 within 2 h. Conclusions Escalation of patient observations, monitoring and medical reviews matching the BedsidePEWS is still suboptimal. Children with CHC are at higher risk of lower compliance. Impact of adherence to predefined response algorithms on patient outcomes should be further explored.

scholarly journals Implementation and adherence to the Bedside Paediatric Early Warning System (BedsidePEWS) in a pediatric tertiary care hospital

2020 ◽  
Author(s):  
Orsola Gawronski ◽  
Federico Ferro ◽  
Corrado Cecchetti ◽  
Marta Luisa Ciofi Degli Atti ◽  
Immacolata Dall'oglio ◽  
...  
Keyword(s):  
Early Warning ◽  
Early Warning System ◽  
Tertiary Care ◽  
Vital Signs ◽  
Warning System ◽  
Hospital Inpatient ◽  
Care Hospital ◽  
Clinical Records ◽  
Hospital Wards ◽  
Score Range

Abstract BackgroundClinical deterioration in children admitted to hospital wards often manifests through signs of increasing illness severity that may lead to unplanned Pediatric Intensive Care Unit admissions or cardiac arrest, if undetected. The Bedside Pediatric Early Warning System (BedsidePEWS) is a validated Canadian scoring system used at a large tertiary care children’ hospital to prevent critical illness and standardize the response to deteriorating children on the wards.MethodsA 6-month audit was performed to evaluate the use of the BedsidePEWS, escalation of patient observations, monitoring and medical reviews on the wards in 2018.Two research nurses performed weekly visits to the hospital wards to collect data on BedsidePEWS scores, medical reviews, type of monitoring and vital signs recorded. Data were described through means or medians according to the distribution. Inferences were calculated either with Chi-square, Student’s t test or Wilcoxon-Mann–Whitney test, as appropriate (P <0.05 considered as significant).ResultsA total of 522 Vital Signs (VS) and score calculations on 177 patient clinical records were observed from 13 hospital inpatient wards. Frequency of VS and score documentation occurred <3 times per day in 33% of the observations. Adherence to the VS documentation frequency according to the hospital protocol was observed in 54% for all patients; for children with chronic health conditions (CHC) it was significantly lower than children admitted for acute medical conditions (47%, P=0.006). The BedsidePEWS score was correctly calculated and documented in 84% of the observed VS documentation events. Systolic blood Pressure was recorded in 79% and Temperature in 91% of the VS recording events. Patients within a 0-2 BedsidePEWS score range were all reviewed at least once a day by a physician. Only 50% of the patients in the 5-6 score range were reviewed within 4 hours and 42% of the patients with a score ≥7 within 2 hours. Transcutaneous Oxygen Saturation continuous monitoring was applied to 60% of the children at higher risk (BedsidePEWS ≥5).ConclusionsEscalation of patient observations, monitoring and medical reviews matching the BedsidePEWS is still suboptimal. Children with CHC are at higher risk of lower compliance. Impact of adherence to predefined response algorithms on patient outcomes should be further explored.

scholarly journals Implementation and adherence to the Bedside Paediatric Early Warning System (BedsidePEWS) in a pediatric tertiary care hospital

2020 ◽  
Author(s):  
Orsola Gawronski ◽  
Federico Ferro ◽  
Corrado Cecchetti ◽  
Marta Luisa Ciofi Degli Atti ◽  
Immacolata Dall'oglio ◽  
...  
Keyword(s):  
Early Warning ◽  
Tertiary Care ◽  
Vital Signs ◽  
Hospital Inpatient ◽  
Care Hospital ◽  
Transcutaneous Oxygen ◽  
Transcutaneous Oxygen Saturation ◽  
Clinical Records ◽  
Hospital Wards ◽  
Score Range

Abstract Background Escalation of care in deteriorating children admitted to hospital wards in relation to pediatric early warning scores has been rarely reported. The aim of this study is to examine adherence to the vital signs and BedsidePEWS escalation protocol at a large tertiary care children’s hospital.Methods This is a prospective observational study. A 6-month audit on adherence to BedsidePEWS was performed on the wards in 2018. Data on the frequency and accuracy of BedsidePEWS score calculations, escalation of patient observations, monitoring and medical reviews were recorded.Two research nurses performed weekly visits to the hospital wards to collect data on BedsidePEWS scores, medical reviews, type of monitoring and vital signs recorded. Data were described through means or medians according to the distribution. Inferences were calculated either with Chi-square, Student’s t test or Wilcoxon-Mann–Whitney test, as appropriate (P <0.05 considered as significant).Results A total of 522 Vital Signs (VS) and score calculations on 177 patient clinical records were observed from 13 hospital inpatient wards. Frequency of VS and score documentation occurred <3 times per day in 33% of the observations. Adherence to the VS documentation frequency according to the hospital protocol was observed in 54% for all patients; for children with chronic health conditions (CHC) it was significantly lower than children admitted for acute medical conditions (47%, P=0.006). The BedsidePEWS score was correctly calculated and documented in 84%, systolic blood pressure was recorded in 79% and temperature in 91% of the VS recording events. Patients within a 0-2 BedsidePEWS score range were all reviewed at least once a day by a physician. Only 50% of the patients in the 5-6 score range were reviewed within 4 hours and 42% of the patients with a score ≥7 within 2 hours. Transcutaneous Oxygen Saturation continuous monitoring was applied to 60% of the children at higher risk (BedsidePEWS ≥5).Conclusions Escalation of patient observations, monitoring and medical reviews matching the BedsidePEWS is still suboptimal. Children with CHC are at higher risk of lower compliance. Impact of adherence to predefined response algorithms on patient outcomes should be further explored.

Development of a Pediatric Early Warning System Using Data-Driven Vital Signs

PEDIATRICS ◽  
2016 ◽  
Vol 137 (Supplement 3) ◽  
pp. 256A-256A
Author(s):  
Catherine Ross ◽  
Iliana Harrysson ◽  
Lynda Knight ◽  
Veena Goel ◽  
Sarah Poole ◽  
...  
Keyword(s):  
Early Warning ◽  
Early Warning System ◽  
Vital Signs ◽  
Warning System ◽  
Data Driven ◽  
Using Data

scholarly journals Pemberdayaan Perawat dalam Penerapan Nurse Early Warning System untuk Memantau Kondisi Pasien di Rumah Sakit

2020 ◽  
Vol 2 (2) ◽  
pp. 135
Author(s):  
Junaedi Yunding ◽  
Masyita Haerianti ◽  
Evidamayanti Evidamayanti ◽  
Evawaty Evawaty ◽  
Indrawati Indrawati
Keyword(s):  
Early Warning ◽  
Early Warning System ◽  
Emergency Services ◽  
Vital Signs ◽  
Warning System ◽  
Independent Practice ◽  
Knowledge And Skills ◽  
Detection Tool ◽  
Service Institution ◽  
Implementation Method

AbstractSevere adverse events such as cardiac arrest and death are often marked by abnormal vital signs a few hours before the event. Majene Regional General Hospital is the only hospital in the Majene Regency and is a reference center for all puskesmas in the Majene and surrounding districts. As a health service institution that organizes health services, it is closely related to the responsibility of providing emergency services. The Nurse Early Warning System (NEWS) is a development in emergency services for patients treated in hospitals, which serves as an early detection tool so that if there is a decrease in the patient's condition it can be known earlier can be handled more quickly. The purpose of this activity is to increase the knowledge and skills of nurses in the application of the nurse early warning system (NEWS) in monitoring the condition of patients in the care room. The implementation method starts from identifying the problem, delivering material about NEWS, demonstrating the assessment of the patient's condition and the nurse's independent practice in using NEWS. The evaluation results of this activity are the increase in knowledge and skills of nurses using NEWS in monitoring the condition of patients in the care room.

scholarly journals Development and evaluation of a novel Vital Signs Alert device for use in pregnancy in low-resource settings

2018 ◽  
Vol 4 (4) ◽  
pp. 192-198 ◽  
Author(s):  
Hannah L Nathan ◽  
Nicola Vousden ◽  
Elodie Lawley ◽  
Annemarie de Greeff ◽  
Natasha L Hezelgrave ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Early Warning ◽  
Early Warning System ◽  
Healthcare Providers ◽  
Vital Signs ◽  
Warning System ◽  
Evidence Based ◽  
Traffic Light ◽  
Low Resource Settings ◽  
In Pregnancy

ObjectivesHaemorrhage, hypertension, sepsis and abortion complications (often from haemorrhage or sepsis) contribute to 60% of all maternal deaths. Each is associated with vital signs (blood pressure (BP) and pulse) abnormalities, and the majority of deaths are preventable through simple and timely intervention. This paper presents the development and evaluation of the CRADLE Vital Signs Alert (VSA), an accurate, low-cost and easy-to-use device measuring BP and pulse with an integrated traffic light early warning system. The VSA was designed to be used by all cadres of healthcare providers for pregnant women in low-resource settings with the aim to prevent avoidable maternal mortality and morbidity.MethodsThe development and the mixed-methods clinical evaluation of the VSA are described.ResultsPreliminary fieldwork identified that introduction of BP devices to rural clinics improved antenatal surveillance of BP in pregnant women. The aesthetics of the integrated traffic light system were developed through iterative qualitative evaluation. The traffic lights trigger according to evidence-based vital sign thresholds in hypertension and haemodynamic compromise from haemorrhage and sepsis. The VSA can be reliably used as an auscultatory device, as well as its primary semiautomated function, and is suitable as a self-monitor used by pregnant women.ConclusionThe VSA is an accurate device incorporating an evidence-based traffic light early warning system. It is designed to ensure suitability for healthcare providers with limited training and may improve care for women in pregnancy, childbirth and in the postnatal period.

scholarly journals Relationship between Nurses’ Knowledge of Initial Assessment and Application of Early Warning System At Emergency Department of Type A Hospital In Jakarta

2020 ◽  
Vol 4 (1) ◽  
pp. 12
Author(s):  
Sekar Dwi Purnamasari ◽  
Denissa Faradita Aryani
Keyword(s):  
Emergency Department ◽  
Early Warning ◽  
Early Warning System ◽  
Patient Flow ◽  
Vital Signs ◽  
Warning System ◽  
Initial Assessment ◽  
Emergency Nurses ◽  
Cross Sectional ◽  
Nurses Knowledge

<div class="WordSection1"><p class="AbstractContent"><strong>Objective:</strong> Early warning system (EWS) is a physiological scoring to observe the patient’s condition not only in hospital wards but also in Emergency Department (ED). At an overcrowded ER that have slow of patient flow, EWS is use as an early detection of patient’s deterioration by observing the vital signs. The purpose of this study was to identify the relationship between nurses’ knowledge of initial assessment and the application of EWS at emergency department.</p><p class="AbstractContent"><strong>Methods: </strong>This was a quantitative study that used descriptive correlative with cross-sectional design toward 70 emergency nurses.</p><p class="AbstractContent"><strong>Results:</strong> The result showed there was a relationship between nurses’ knowledge of initial assessment and the application of early warning system at emergency room <em>(p</em>=0 .001)<strong></strong></p><p><strong>Conclusion: </strong>The higher the level of nurses’ knowledge, their behavior is better. It is recommended to maintain the use of EWS in ED that already good through training regularly (re-certification).</p><p class="AbstractContent"><strong> </strong></p><div><p class="Keywords"><strong>Keywords: </strong>Early warning system; emergency department; initial assessment; nurses’ knowledge.</p></div></div>

scholarly journals Experience in the implementation of the early warning sign system in obstetric patients (Maternal Early Warning Criteria, MEWC) during early postpartum. A prospective observational study.

2020 ◽  
Author(s):  
Cristina Ibanez ◽  
Ruben Casans-Frances ◽  
Soledad Bellas ◽  
Luis Enrique Munoz
Keyword(s):  
Blood Pressure ◽  
Multivariate Analysis ◽  
Early Warning ◽  
Tertiary Care ◽  
False Negative ◽  
Warning System ◽  
High Specificity ◽  
Warning Sign ◽  
Care Hospital ◽  
Low Sensitivity

Objective: To evaluate the implementation of an early warning system in obstetric patients (MEWC) during the first two hours after delivery in a single tertiary-care hospital. Methods: The MEWC system implementation was carried out from 15th March to 15th September 2018, over 1166 patients. The parameters collected were systolic and diastolic blood pressure, heart rate, oxygen saturation, diuresis, uterine involution, and bleeding. If a parameter was not within defined limits, an obstetrician first examined the patient, determining the need to call the anesthesiologist. We carried out a sensitivity-specificity study of the trigger and multivariate analysis of the factors involved in developing potentially fatal disorders (PFD), reintervention, critical care admission, and stay. Results: The protocol was triggered in 75 patients (6.43%). The leading cause of alarm activation was the altered systolic blood pressure (32 [42.7%] patients), and eleven developed PFD. Twenty-eight patients were false-negatives. Sensitivity and specificity of MEWC protocol were 0.28 (0.15, 0.45) and 0.94 (0.93, 0.96), respectively. Multivariate analysis showed a relationship between alarm activation and PFD. Conclusion: Our MEWC protocol presented low sensitivity and high specificity, having a significant number of false-negative patients.

scholarly journals Introduction of a modified obstetric early warning system ­(­MOEWS­)­ at an Ethiopian referral hospital: a feasibility assessment

2019 ◽  
Vol 8 (1) ◽  
pp. e000503 ◽  
Author(s):  
Jolene Moore ◽  
Duncan Thomson ◽  
Iona Pimentil ◽  
Bazezew Fekad ◽  
Wendy Graham
Keyword(s):  
Early Warning ◽  
Early Warning System ◽  
Healthcare Workers ◽  
Vital Signs ◽  
Warning System ◽  
Referral Hospital ◽  
Early Warning Score ◽  
Low Resource ◽  
Senior Clinician ◽  
Early Warning Scores

Early warning scores are points-based or colour-coded systems used to detect changes in physiological parameters and prompt earlier recognition and management of deteriorating patients. Vital signs recorded within a coloured zone corresponding to degree of derangement (‘trigger’) should prompt an action. The report of the UK Confidential Enquiry into Maternal and Child Health recommends the use of modified versions in the obstetric population. Currently, there is limited research into the effects of early warning scores in low-resource settings where maternal mortality remains high, and there is a need for low-cost, simple methods to reduce this. A modified obstetric early warning system (MOEWS) was introduced for parturients who had undergone surgical intervention at Felege Hiwot Referral Hospital, a tertiary centre in Bahir Dar, Ethiopia. A guideline was developed to accompany the MOEWS, together with training of healthcare workers. Prior to introduction, the quality of postoperative monitoring was assessed through retrospective case note review. This was reassessed at 8 months and 11 months postimplementation, with assessment of response to ‘triggers’. A questionnaire and qualitative interviews were undertaken to establish views of healthcare workers on its acceptability and usability. Recording of postoperative vital signs improved with the implementation of the MOEWS and was sustained at both monitoring periods. The number of patients with vital signs within the coloured zones (‘trigger’) was reduced, although documented action to these remained low. Staff were positive towards the MOEWS, its impact on patient care and felt confident using the system. The introduction of a MOEWS in an Ethiopian referral hospital in this study appeared to improve the monitoring of postoperative patients. With modifications to suit the setting and senior clinician involvement, coupled with regular training, the early warning score is a feasible and acceptable tool to cope with the unique demands faced in this low-resource setting.

scholarly journals P0177 / #1171: ADHERENCE TO THE BEDSIDE PAEDIATRIC EARLY WARNING SYSTEM IN A TERTIARY CARE PEDIATRIC HOSPITAL

2021 ◽  
Vol 22 (Supplement 1 3S) ◽  
pp. 114-114
Author(s):  
O. Gawronski ◽  
F. Ferro ◽  
C. Cecchetti ◽  
M. Ciofi Degli Atti ◽  
I. Dall’Oglio ◽  
...  
Keyword(s):  
Early Warning ◽  
Early Warning System ◽  
Tertiary Care ◽  
Warning System ◽  
Pediatric Hospital
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