A survey of healthcare professionals ’ experiences with the Paediatric Early Warning Score ( PEWS )

Kjersti Sønning Spesialsykepleier til barn Nyfødtintensiv avdeling, Oslo universitetssykehus, RH Cathrine Nyrud Spesialsykepleier til barn Nyfødtintensiv avdeling, Oslo universitetssykehus, US Ingrid Helen Ravn Førsteamanuensis Institutt for sykepleie og helsefremmende arbeid, HiOA Authors Background: The Paediatric Early Warning Score (PEWS) is a scoring tool that was developed in the early 2000s in England and modi ed for Norwegian conditions in 2011. The tool quanti es the severity of children’s clinical condition, regardless of diagnosis, and identi es children between 0 and 18 years of age who are at risk of clinical deterioration. PEWS is regarded as a useful tool for recognising at-risk patients, but research on user experiences with PEWS is limited. Purpose: To describe the experiences of nurses and doctors with PEWS. We describe these experiences in terms of whether the tool contributes to a systematic approach to monitoring and better communication, as well as whether the tool is applicable to the user. In addition, we investigate whether PEWS is used according to established guidelines and whether different hospitals or professional groups have different experiences with the tool. Method: We used a quantitative method with a descriptive cross-sectional design. We developed our own questionnaire to survey the user experiences of 172 healthcare professionals at three Norwegian hospitals, and performed descriptive analyses with nonparametric rank-sum tests (Kruskal-Wallis and Mann-Whitney-Wilcoxon). Results: There is general agreement among the healthcare professionals that PEWS promotes a systematic approach to monitoring and better communication and that PEWS is a userfriendly tool. The healthcare professionals at one hospital agreed signi cantly more often that they use PEWS according to established guidelines, as compared with the other hospitals. Conclusion: The healthcare professionals report positive experiences with PEWS, but the study shows that they use the guidelines in very different ways. It is the responsibility of paediatric nurses to ‘evaluate acute situations, set priorities and implement measures that help to maintain or restore vital functions’ (1). This requires systematic monitoring of children who are hospitalised. To prevent acute situations, nurses must quality assure the monitoring of sick children so that any deterioration in the child’s clinical condition can be identified at an early stage. The Paediatric Early Warning Score (PEWS) is a scoring tool that quantifies the severity of children’s clinical condition, regardless of diagnosis. Monaghan’s version of PEWS, which was developed in the early 2000s in England, was translated into Norwegian, modified and validated in 2011 at Akershus University Hospital. Paediatric Early Warning Score (PEWS) A growing number of paediatric departments in Norway have implemented the tool, and a joint initiative to implement the tool nationally is currently underway. The tool is based on normal values on clinical parameters according to the child’s age (0–18 years) within three categories: respiration (AB), circulation (C) and behaviour (D). Increasing deviation from normal values for the child’s age raises the score. A total score indicates the patient’s risk of clinical deterioration (2). Several validation studies of PEWS have been carried out (3–10). Individual studies are summarised in review articles (11, 12), and reports discuss the implementation of PEWS and evaluate the tool (4, 13, 14). Research shows that PEWS improves, to varying degrees, the ability of healthcare professionals across professions to identify early clinical deterioration in sick children. A survey of employees’ experiences following the implementation of PEWS (13) and a collection of nurses’ feedback on the use of PEWS show that PEWS gives nurses more self-confidence in their work with sick children. They are uncertain, however, whether their own assessment skills are more effective than the tool (14). Researchers are seeking more knowledge about users’ experiences of the tool’s applicability. If healthcare professionals are to prevent and identify clinical deterioration and improve the outcome of treatment by using PEWS, the healthcare professionals group must focus on continuing to use the tool (15). «PEWS gives nurses more self-confidence in their work with sick children. » Purpose of the study