Creating an Exception Algorithm
The multidisciplinary team’s development and use of an
“exception algorithm” was effective and efficient in managing
patients with chronic conditions, such as anemia,
that can lead to persistent elevated PEWS scores in children
that were hemodynamically stable.
The exception algorithm allows the care team to design
a patient-specific plan of care when a child has 3 consecutive
scores of 5 or above but is considered medically stable. The patient-specific plan is reevaluated at least
every 24 hours. The exception algorithm tailors interventions
to the particular child’s situation. The plan may be as
general as calling the physician if the patient scores one
level higher or as specific as to call if heart rate increases
by a determined rate and/or the child is not able to maintain
oxygen saturation above a predetermined level such
as 90%.