Chapter 4 Identifying Deterioration Early

Chapter 4: Identifying Deterioration Early At the core of improving outcomes for paediatric patients is the recognition and response to the deteriorating child. The earlier this deterioration is spotted, the better the outcome is likely to be. This Chapter will focus on how we respond to deterioration with specific guidance on Paediatric Early Warning Scores and Systems (PEWS), as well as some leading examples.

Paediatric Early Warning Scores and Systems Aim to assist in the identification of deteriorating children Do not replace clinical judgement Different versions all with similar specificity and sensitivity Key is to use a standard one for the organisation

Ideal PEWS Tool Validated Easy to use Practical Generic One Document Meet’s Hospital’s needs

Score or Threshold/Trigger? Some tools use a scored system which requires values of each observation to be added together to generate a score which determines the response. Others use a system where scores aren’t used and if one observation fall outside the normal range, an appropriate response is required

Score or Threshold/Trigger? Both systems have their strengths and weaknesses: System Scored Threshold/Trigger Example strength Takes all observations into consideration Can provide a needed response when only one observation is triggering. Example weakness Can lead to mathematical errors and potentially incorrect response Can lead to increase in number of responses required.

PEWS-SBAR Handover Patient 1 Patient 2 Patient 3 Patient 4

RECALL It is important to assess deterioration in real time The Recall tool developed at Great Ormond Street Hospital allows for rapid assessment of why a child deteriorated and whether all systems in place were sensitive Allows review of PEWS

Re-Act Talks The resource pack provides a link to a series of Re-ACT talks, videos that provide information on key areas for consideration in decreasing unexpected deterioration.

Watchers Sometimes a patient’s observations may be completely normal. At the same time, you may feel that something is not quite right and that further observation is needed. This is a watcher and relies on your clinical instinct. It can’t be measured by charts, but should always be trusted.