Aim Improving recognition of deteriorating in children in hospital is the key driver for the RCPCH S.A.F.E. project. Electronic patient records present opportunities to improve patient safety through reducing errors in recording. We developed and implemented a paediatric electronic observation system with automatic calculation of Paediatric Advanced Warning Score (PAWS). It was anticipated that this would improve outcomes, through better observation recording and PAWS calculation, prompting appropriate escalation of deteriorating patients.
Method Adult electronic adult observation and scoring systems were already in use in our trust. Our system built on that, allowing automatic selection of the correct age parameters and calculation of the PAWS using inputted observations. It also included escalation prompts. Staff training on assessment, observation standards, recognition of sick children, and the electronic system preceded the introduction. Anticipated outcomes of reduced unplanned transfers to PICU and mortality on the paediatric ward were considered to be difficult to evidence since these events are rare. Therefore process measures were used to demonstrate improvement. Data was collected pre-implementation, at 2 months and 7 months post implementation.
Results Recording of observations, calculation of PAWS and escalation improved following the introduction of the electronic system. The correct age chart is now used for all patients. The correct PAWS are recorded 96% of the time now compared with 70% pre implementation. (Of those requiring transfer to PICU this was 100% vs. 31%). Frequency of observations was only prescribed in 16% pre-implementation. Frequency is now automatically updated with 99% compliance after 2 months. Escalation of ward patients improved from 56% to 82%.
Conclusion Recording of PAWS and escalation has improved following the introduction of the electronic system. Documentation of medical reviews requires improvement. There is ongoing development of the electronic system e.g. recent addition of neuro-observations. The electronic system has been primarily designed to reduce error, making it easy for staff to do the right thing. Early warning scores should be not used in isolation. Used in combination with other S.A.F.E strategies, such as improved team and parent communications, we hope to demonstrate an improvement in unplanned transfers to PICU and mortality.
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