Purpose
The purpose of this manuscript is to describe the
implementation and subsequent modifications of the
CHEWS tool and its companion Escalation of Care
Algorithm for pediatric cardiovascular patients and early
detection of deterioration and prevention of cardiopulmonary
arrests or unplanned transfers to a cardiac ICU (CICU).
Methods
Tool Modification
A pilot study consisting of current electronic health
record documentation and clinician interview was implemented
on the cardiac unit. A single staff nurse, qualified
in the use of the CHEWS tool, scored all the patients
(n=27; observations=157) on the unit during two
consecutive 12-hour shifts. Scores were based on documentation
in patients' electronic health records. The pilot
study nurse concurrently interviewed the charge nurse and
the patients' nurses, nurse practitioners or fellows and
asked each of them to identify which of the their patients
were most acute and/or had them concerned. Nurses
indicated during the interviews whether patients' families
had concerns or were absent from the bedside and this
information was utilized to score the “family concern”