Ongoing Monitoring, Evaluation, and Education
Once the algorithm was activated, there was ongoing
review of patient scores and staff actions in response to
the scores in order to evaluate staff members” ability to
score accurately, consistently, and follow the algorithm
(Figure 3). Initially, weekly scoring and algorithm compliance
were monitored to ensure interrater reliability by
having 2 nurses independently score selected patients and
comparing their PEWS score results. Consistent scoring
among staff members improved over time (Figure 9).
ICU transfers and associated PEWS scoring trends were
also reviewed in order to evaluate the appropriateness of
algorithm actions.
Periodic PEWS Implementation Team meetings followed,
and the compiled data were reviewed to ensure a
sound algorithm design. Since its inception in September
2007, the algorithm has undergone 3 revisions. Each
refinement was based on both reviewed data and feedback
from all care team members.