PEWS Implementation in an LMIC Setting

Study Overview
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Brief Summary
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The PEWS implementation study will be undertaken with the following objectives: Assess the effectiveness of implementation of PEWS and resuscitation training to identify patients at risk for clinical deterioration and to impact the frequency of clinical interventions made by treating providers on these patients. Assess the effectiveness of implementation of PEWS and resuscitation training to impact time sensitive clinical interventions made on patients at risk for clinical deterioration. Assess the impact of implementation of PEWS and resuscitation training on length of stay for patients admitted to the pediatric oncology ward.

Official Title
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Implementation of Pediatric Early Warning Scores and a Context-adapted Resuscitation Training Course to Improve Outcomes in an LMIC Pediatric Inpatient Oncology Ward

Conditions
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Oncology

Intervention / Treatment
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* Other: pediatric early warning scoring system and resuscitation curriculum


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients eligible for the study are defined as pediatric patients (between birth and 12 years of age) admitted and subsequently discharged from the pediatric oncology ward in Beit Jala, Palestine and Gaza City, Palestine between March 2019 to June 2020 Exclusion Criteria: Patients will be excluded if they are not admitted to inpatient status. No oncology outpatients such as those in the infusion program will be included.

Ages Eligible for Study
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Minimum Age: 0 Years
Maximum Age: 12 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Other: Inpatient pediatric oncology patients<br>All patients admitted to the pediatric oncology ward will be in the cohort | Other: pediatric early warning scoring system and resuscitation curriculum<br>* teaching resuscitation to medical providers and implementing a scoring tool to help identify patients at risk for clinical deterioration in an inpatient setting<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Elevated Pediatric Early Warning Score (PEWS) | frequency of patients whose PEWS score indicates 'risk for clinical deterioration' and receive a clinical intervention. PEWS 3 or greater (Scale is PEWS 0-6) is defined as at risk for clinical deterioration with a higher score concerning for worse clinical outcome. | 1 year | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Time to antibiotics | Time to antibiotics defined as time from documented vital signs/PEWS to time of antibiotic administration measured in minutes | 1 year | 
| Time to IV fluid bolus | Time to fluids defined as time from documented vital signs/PEWS to time of documented IV fluid bolus measured in minutes | 1 year | 
| Volume of IV fluids | Volume of fluids received defined as volume given up to 60 minutes after the initiation of the first fluid bolus measured in milliliters | 1 year | 
| Length of stay | Length of stay for all patients admitted to the inpatient ward | 1 year |