The Toronto PEW System Score is a tool that is comprised of two components, static and dynamic. When the tool is used consistently as part of a routine nursing assessment, it allows the bedside nurse to quantify a score. As the patient deteriorates, the score rises, indicating an increased risk for cardio-pulmonary arrest. Subtle changes in the child can be trended over time providing an early warning for the healthcare team.
The static or more concrete variables do not change with every assessment. These ask whether the child has: an abnormal airway; been on home oxygen; a Central Venous line; had a transplant; Cerebral Palsy; a Gastrostomy tube; been in ICU this admission or greater than three medical specialties involved in their care.3 Each of the variables requires a Yes/No answer. One point is scored for every “Yes” response. The maximum score a child can have from the static component is eight points.
The second component utilizes age appropriate dynamic or physiological variables. The variables that make up the dynamic component of the tool are: vitals signs, oxygen saturations, oxygen therapy, pulses, capillary refill, level of consciousness, whether a fluid bolus has been given and amount of medications the child is on.3 As children have different normal parameters for vital signs based on age, there are age specific criteria embedded within the PEW System Score. The maximum score the child can have from the dynamic variables is 24 points.
These two components when scored together assess indicators that the child is at risk for deterioration. These indicators include co-morbidities and physiological responses to illness.
The Toronto PEW System Score will be implemented this fall in the acute care areas. The aim is to eradicate acute care codes entirely, with a short term goal of a 50% reduction in the first year. A prospective study will be undertaken to evaluate clinical significance and if modifications may improve this tool’s efficacy in identifying deterioration in our patients.