Table 2

Principles underlying maturity at each level (relevant to inpatient wards)

Level 1 (PEWS 1.0—relevant to majority of hospitals)
  • Observation and monitoring guidance aligned to RCN guidance on vital signs measurement in CYP24

  • Use of standardised observation charting to transfer physiological data into a composite score

  • In use in all paediatric inpatient care areas in the organisation

  • Regular audit of practice on vital signs measurement and escalation

Level 2 (PEWS 2.0—relevant to selection of hospitals)
  • PEWS includes subjective data (eg, parent/carer/professional concern)

  • Policy and practice acknowledge situational awareness with PEWS part of a wider system that may include watchers, huddles and senior walk rounds

  • Escalation processes and communication tools such as SBAR in operation

  • Key outcomes monitored on regular basis

  • Evidence of iterative feedback and engagement with staff

  • In use in paediatric emergency departments and assessment units in some hospitals

Level 3 (PEWS 3.0—for introduction in 2021+)
  • A standardised approach to educating staff in recording observations (objective and subjective) in all environments (primary/secondary/tertiary care)

  • Evidence of initiatives to develop and demonstrate cultures in healthcare environments to foster the reduction of hierarchy between staff and parent/carers and within specialty and professional groups of all grades

  • Utilisation of national principles for ‘standards for escalation’

  • A route map to electronic data collection clear for each trust

  • CYP, children and young people; PEWS, paediatric early warning systems; RCN, Royal College of Nursing; SBAR, situation, background, assessment, response.