Dean Nathan P, Cheng Jenhao J, Crumbley Ian, DuVal Jennifer, Maldonado Eliana, Ghebremariam Emanuel
Department of Pediatrics, Children's National Health System, The George Washington School of Medicine.
Department of Quality and Patient Safety, Children's National Health System.
Pediatr Qual Saf. 2020 Mar 25;5(2):e278. doi: 10.1097/pq9.0000000000000278. eCollection 2020 Mar-Apr.
Accurate and timely documentation of pediatric early warning scores (PEWS) by the bedside nurse into the electronic health record (EHR) is important to promote early identification of patients in stages of deterioration. Through the implementation of a PEWS calculator embedded in the EHR, we hope to improve the accuracy of the recorded score and reduce the time between vital sign collection and final documentation in the EHR.
Identification of the highest PEWS value in the 24 hours before all unplanned transfers or rapid response activations without a transfer occurred between the period November 1, 2013, through December 31, 2016. The accuracy of the calculated cardiac or respiratory subscore based on heart rate or the respiratory rate at the time of PEWS calculation was determined. We tracked the calculation of the time to chart via the difference between nursing documentation of PEWS compared to vital sign collection. Before September 3, 2015, PEWS was calculated mentally by the bedside nurse; afterward, the nurse entered the unique PEWS features into the EHR, and the EHR automatically calculated PEWS.
This study evaluated 2,409 PEWS scores, 1,411 before and 998 after initiation of the PEWS calculator. Accuracy before the EHR calculator was 71%, and the median time to document was 55 minutes. Following the implementation of the calculator, no scores were incorrectly calculated too low, and the median time to document was 20 minutes.
Transition to an EHR-based PEWS calculator eliminated inaccurately low PEWS values and reduced time to document.
床边护士准确及时地将儿科早期预警评分（PEWS）记录到电子健康记录（EHR）中，对于促进早期识别病情恶化阶段的患者非常重要。通过在电子健康记录中嵌入PEWS计算器，我们希望提高记录评分的准确性，并减少生命体征采集与电子健康记录最终记录之间的时间。
确定2013年11月1日至2016年12月31日期间所有非计划转运或未发生转运的快速反应激活前24小时内的最高PEWS值。确定基于PEWS计算时的心率或呼吸频率计算的心脏或呼吸子评分的准确性。我们通过比较PEWS的护理记录与生命体征采集之间的差异来跟踪记录时间的计算。2015年9月3日之前，床边护士通过心算计算PEWS；之后，护士将独特的PEWS特征输入电子健康记录，电子健康记录自动计算PEWS。
本研究评估了2409个PEWS评分，其中在PEWS计算器启用前有1411个，启用后有998个。电子健康记录计算器启用前的准确率为71%，记录的中位时间为55分钟。计算器实施后，没有评分被错误地计算得过低，记录的中位时间为20分钟。
向基于电子健康记录的PEWS计算器过渡消除了不准确的低PEWS值，并减少了记录时间。
