G232(P) Prevalence of elevated PEWS scores in a Specialist Children's Hospital: snapshot audit. (7th April 2014)

• Record Type: Journal Article
• Authors: Sundaram, M; Duncan, H
• Is Part Of: Archives of disease in childhood. Volume 99:Supplement 1(2014)
• Page Start: A99
• Page End: A99
• Publication Date: 2014-04-07
• Subjects: Children -- Diseases -- Periodicals; Infants -- Diseases -- Periodicals; 618.920005
• DOI: 10.1136/archdischild-2014-306237.226
• Languages: English
• ISSNs: 0003-9888

Abstract

Abstract : Introduction: Early Warning Scores are associated with an increase in early detection of illness (true positive), high scores without clinical deterioration (false positive) and clinician over-ride or alarm fatigue that leads to missed detection (false negative). Aim: To establish the prevalence of false positive and false negative alerts generated by the Paediatric Early Warning Score (PEWS) Methods: Data collection occurred on three different days selected purposefully for when the hospital would have the maximum number of patients and a representative case mix of medical and surgical patients. The PEWS score and physiological parameters for the patients were entered on a secure database. For patients with high PEWS (>/= 9), notes were reviewed and nursing staff were contacted for clarification of the action taken and bedside management and escalation plan. This is similar to routine Trust wide safety audits. Results: 248 patients' PEWS charts from 300 inpatient beds were reviewed over 3 days. 87% of the patients had observations in their PEWS chart, with a physiological value against their PEW score. PEWS were scored more >9 in 2%, 5–8 in 13% and 1–4 in 85% of patients. Majority of the patients with high PEWS were from the cardiac, respiratory and post-operative units. In 46 and 57% of the patients with PEWS >/= 9 and 4–8 respectively, inappropriate response was taken. During this period 4 of the patients were admitted to the PICU from the wards. Conclusion: 2% of patients had score >/= 9 and so even if these are false positives it is a small burden. Clinicians do override the PEWs recommendations. Is this due to poor calibration of the score or clinician disbelief?