Boston Children's Hospital, Boston, USA.
Harvard Medical School, Boston, USA.
BMC Health Serv Res. 2021 Oct 26;21(1):1159. doi: 10.1186/s12913-021-07157-x.
Pediatric Early Warning Scores (PEWS) are nurse-administered clinical assessment tools utilizing vital signs and patient signs and symptoms to screen for patients at risk for clinical deterioration. When utilizing a PEWS system, which consists of an escalation algorithm to alert physicians of high risk patients requiring a bedside evaluation and assessment, studies have demonstrated that PEWS systems can decrease pediatric intensive care (PICU) utilization, in-hospital cardiac arrests, and overall decreased mortality in high income settings. Yet, many hospital based settings in low and lower middle income countries (LMIC) lack systems in place for early identification of patients at risk for clinical deterioration.
A contextually adapted 16-h pediatric resuscitation program included training of a PEWS tool followed by implementation and integration of a PEWS system in a pediatric hematology/oncology ward in Beit Jala, Palestine. Four PDSA cycles were implemented post-implementation to improve uptake and scoring of PEWS which included PEWS tool integration into an existing electronic medical record (EMR), escalation algorithm and job aid implementation, data audits and ward feedback.
Frequency of complete PEWS vital sign documentation reached a mean of 89.9%. The frequency and accuracy of PEWS scores steadily increased during the post-implementation period, consistently above 89% in both categories starting from data audit four and continuing thereafter. Accuracy of PEWS scoring was unable to be assessed during week 1 and 2 of data audits due to challenges with PEWS integration into the existing EMR (PDSA cycle 1) which were resolved by the 3rd week of data auditing (PDSA cycle 2).
Implementation of a PEWS scoring tool in an LMIC pediatric oncology inpatient unit is feasible and can improve frequency of vital sign collection and generate accurate PEWS scores.
This study demonstrates how to effectively implement a PEWS scoring tool into an LMIC clinical setting. This study demonstrates how to utilize a robust feedback mechanism to ensure a quality program uptake. This study demonstrates an effective international partnership model that other institutions may utilize for implementation science.
儿科早期预警评分（PEWS）是一种由护士管理的临床评估工具，利用生命体征和患者体征及症状来筛查有临床恶化风险的患者。当使用 PEWS 系统时，该系统包括一个警戒算法，用于提醒医生高风险患者需要床边评估，研究表明 PEWS 系统可以减少儿科重症监护病房（PICU）的使用、院内心脏骤停以及高收入环境下的整体死亡率。然而，许多中低收入国家（LMIC）的医院缺乏用于早期识别有临床恶化风险的患者的系统。
在巴勒斯坦 Beit Jala 的儿科血液/肿瘤科病房中，实施了一项经过上下文调整的 16 小时儿科复苏计划，包括培训 PEWS 工具，然后实施和整合 PEWS 系统。实施后进行了 4 个 PDSA 循环，以提高 PEWS 的采用率和评分，包括将 PEWS 工具整合到现有的电子病历（EMR）中、实施警戒算法和作业辅助工具、数据审核和病房反馈。
完全记录 PEWS 生命体征的频率达到了平均 89.9%。在实施后期间，PEWS 评分的频率和准确性稳步提高，两个类别都在数据审核 4 开始后始终保持在 89%以上。由于 PEWS 整合到现有 EMR 中存在挑战（PDSA 循环 1），因此在数据审核的第 1 周和第 2 周无法评估 PEWS 评分的准确性，这些问题在数据审核的第 3 周（PDSA 循环 2）得到解决。
在中低收入国家儿科肿瘤住院病房实施 PEWS 评分工具是可行的，可以提高生命体征采集的频率并生成准确的 PEWS 评分。
本研究展示了如何在中低收入国家的临床环境中有效地实施 PEWS 评分工具。本研究展示了如何利用强大的反馈机制来确保高质量的项目采用率。本研究展示了一种有效的国际合作模式，其他机构可以利用该模式来实施实施科学。
