We began our implementation and
evaluation of the Monaghan and QuistTherson
PEWS tool in January 2008.
The primary objective of this retrospective
study was to evaluate the sensitivity
of PEWS for a group of patients
who had a documented RRT or code
blue event as well as the lead time for
the earliest and latest critical PEWS before
the event. We hypothesized that at
least 80% of patients had a critical
PEWS, defined as a score of 4 or a
domain score of 3, before the event. If
true, then this would provide evidence
of good sensitivity and support its use
in the pediatric inpatient setting to
identify early physiologic deterioration.
A secondary objective was to examine
staff awareness of deterioration
in patient status before the event
and to determine whether use of PEWS
would have provided significantly earlier
recognition. We measured staff
awareness by key indicators of (1) consultation
with another nurse, physician,
or respiratory therapist; (2) the
addition of monitoring equipment;
and/or (3) increased frequency of patient
assessment.
METHODS
A retrospective chart review was completed
on 170 RRT calls and 16 code
blue events that occurred for 186
unique patients between October 2006
and February 2008. All events occurred
on medical surgical units excluding
ICU and ICU step-down units. Study approval
was obtained from Children’s
institutional review board.