Abstract
Purpose statement: The purpose of this quality improvement project was to implement a PEWS screening process within a rural pediatric inpatient and ED setting.|Background: Deterioration that goes undetected significantly increases the risk of mortality. Cardiac arrest requiring compressions has a survival rate of only 27% versus 80% if clinical deterioration is recognized early. Physiologic changes and early warning signs of can be detected hours before a cardiac arrest. PEWS is a well-known and widely used tool to detect pediatric deterioration in the inpatient and ED settings.|Sample/Setting: The project was implemented in a rural 49-bed hospital with 40 registered nurses. All children ages 0-18 seen in the ED and inpatient unit during the study time frame of 8 weeks were included.|Methods: Education was provided to nurses on PEWS scoring including case studies for inter-rater reliability. Changes were made to the EMR to allow documentation of scoring and a standard of practice policy was developed. Analysis included total screened and trending of PEWS scores.|Results: Of the 101 patients screened in the ED, 8 were transferred, 87.5% of those transferred were compliant with the PEWS score escalation algorithm. Of the 25 patients screened in the inpatient setting, 73% were compliant with the PEWS rescoring policy.|Conclusion: The use of the PEWS tool in a rural ED displays the need for a more widely used EWS system utilization in the aid of escalation protocols to further improve patient outcomes. ED use of the PEWS tool needs further research and more buy-in from other healthcare institutions. The use of the PEWS tool in the inpatient setting continues to be beneficial however needs more education and guidance on rescoring criteria per the PEWS algorithm.