PEWS:

Pediatric Early

Warning Signs,

Rapid Response

Team, Code BlueRoyanne Lichliter BS, RN

And

Jodi Thrasher MS, CFNP, RN

2/4/09

2

You Could Be A Lifesaver TOO!!

3

Background/History

The Children’s Hospital participated in a project with

the CHCA (Child Health Corporation of America) to help

reduce the number of code blues that occur. The PICU

teamed up with the Inpatient Medical Unit, 8th floor, for

this collaborative.

Collaborative goal was to reduce the number of codes

on level 8 by 50% and double the days between codes

in a year.

Custom goal is to decrease emergent intubations

occurring on level 8 or within 1 hour of arrival to PICU

by 50% in a year.

Data summarized from: Tucker, J &

Vossmeyer, M “ Watchful Eye Improving

Patient Safety by Early Identification of Risk

PowerPoint” . Cincinnati Children’ s.

4

Failure to Rescue

• Failure to rescue is defined as

inability to save patient’s life by

Not recognizing deterioration

Failing to take action to reverse

changes

Page 5

Results!!

Our Code Blue rate went from 0.22/1000 patient days to

our current rate of 0.09/1000 patient days.

Our number of emergent intubations decreased from

0.66/1000 patient days to 0.26/1000 currently.

SBAR

Situation, Background, Assessment,

Recommendation

Page 7

SBAR

• Situation: Identify the situation you are calling

about. Identify patient and self. State the

problem

• Background: Provide pertinent back ground

information about the situation, diagnosis,

medications, VS, lab results, code status

• Assessment: What is the assessment of the

situation?

• Recommendation: What do you want?

The PEWS Tool

Page 9

Pediatric Early Warning Signs:

PEWS

0 1 2 3 Score

Behavior •Playing

•Alert

•Appropriate

•At baseline

•Sleep

•Fussy but

consolable

•Irritable/Inconsolable •Lethargic

•Confused

•Reduced response

to pain

Cardiovascular •Pink

•Capillary refill

1-2 seconds

• Pale

• Capillary refill 3

seconds

•Grey

•Capillary refill 4

seconds

•Tachycardia of 20

above normal rate

•Grey

•Mottled

•Capillary refill 5

seconds or above

•Tachycardia of 30

above normal rate

or bradycardia.

Respiratory •Within normal

parameters

• No retractions

•Greater than 10

above normal

parameters

•Use of accessory

muscles

•30+% FiO2

•3+ Liters/minute

•Greater than 20 above

normal parameters

•Retractions

• 40+% FiO2

• 6+ Liters/minute

•Trach &ventilator

dependent

•Below normal

parameters with

retractions

•Grunting.

•50% FiO2

•8+ Liters/minute

Green=0-2 Score Yellow=3 Score Orange=4 score Red =5 or Greater Score

Please Note: Asthma patients on continuous albuterol nebulizers will automatically be a 3 due to respiratory status, please use

clinical judgment and make sure the patient is meeting the criteria for not just tachycardia when rating their cardiovascular

system Adapted from Cincinnati Children's’ PEWS

Page 10

P t admitted to

inpatient unit

Pt assessed/

reassessed by

RN including

PEW S score

PEWS

Score

0-2

P EWS

Score

Totaling

3

PEW S

Score

4

PEW S

S core

5

Reassess and

rescore at next

routine

assessment

Notify resident/

intern and

charge RN of

c linical change

Document and

determine t ime

of next

assessment

and rescoring

Notif y charge RN,

resident /intern ,

supervis ing

resident

Plan and

collaborate with

entire health care

team.

Document and

reassess af ter

intervention .

Continue to

reassess and

rescore every

1 -2 hours

Notify charge RN,

resident /intern ,

supervis ing

resident , nursing

supervisor and

attending

RRT eval

X75555Notify

supervis ing

resident /

attending

If sti ll

concerned

notify attending and

nursing supervisor and

consider

RRT eval

x75555

Plan and

collaborate with

entire health care

team.

Document and

reassess after

intervention .

Continue to

reassess and

rescore every

hour

Pews Flowchart

5/19 /08

Families often know their child best. Please remember to listen to their concerns and advocate for them .

Individual PEWS score

of 3 in any category

Plan and

collaborate with

entire health care

team.

Plan and

collaborate with

entire health care

team.

Page 11

Code Blue

• What it is Activation of an emergency response team, the code team, when patient arrest or rapid decline in a patient

condition

• Who responds Code Team members

• PICU fellow

• PICU charge

• ED charge

• Anesthesia

• Surgery

• Pharmacy

• Nursing Supervisor

• Resource Nurse

• How to call

75555

Operator will ask what your emergency is

State you have a code blue and location

Code Blue Team receives a page

Announced overhead

• When to Call

Respiratory Arrest

Severe respiratory distress

Cardiovascular Arrest

Impending Cardiovascular Arrest

Rapid Response Team

Page 13

Rapid Response Team

• What it is

This is a process to allow any staff or family member to get immediate evaluation of a patient

• Who responds

PICU fellow and charge nurse respond

Goal response time is 10 minute

• How to call

75555

Operator will ask what your emergency is

State you would like a Rapid Response Team and which room number

Rapid response team receives a page on pager

• When to call

Important to escalate concerns through chain of command

Anybody can call

Call when you are worried about patients condition and their potential for decline