Impact of Implementing a Pediatric Early Warning System (PEWS) in a Pediatric Oncology Hospital

Agulnik, Asya; Johnson, Sherry; Wilkes, Regina; Faughnan, Lane; Carrillo, Angela K.; Morrison, R. Ray

doi:10.1097/pq9.0000000000000065

Cited by 9 publications

(12 citation statements)

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“…Nursing ratios in the inpatient wards are 1:2 and in the PICU are 1:1.These hospitals were selected for the study based on their similar missions, patient populations, patient volume, and processes of PEWS implementation. PEWS, or "EVAT", was implemented at UNOP in 2014 (4) and at St. Jude, as "SJAWS", in 2016 (14). Key stakeholders, including ICU physicians, fellows, ward physicians, advance practice practitioners, bedside nurses, and nursing managers, were involved in all stages of implementation at both sites.…”

Section: Methodsmentioning

confidence: 99%

“…During implementation, each hospital conducted weekly monitoring of PEWS documentation by evaluating errors. Both hospitals were able to achieve similarly low error rates during implementation and have maintained these rates through ongoing quality monitoring and re-education (5,14). PEWS algorithms and scoring tools are similar at each site and are included as Supporting Material.…”

Section: Methodsmentioning

confidence: 99%

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Clinician Emotions Surrounding Pediatric Oncology Patient Deterioration

et al. 2021

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BackgroundPediatric oncology patients have a high rate of clinical deterioration frequently requiring critical care. Patient deterioration events are distressing for clinicians, but little is known about how Pediatric Early Warning Systems (PEWS) impact clinicians’ emotional responses to deterioration events.MethodsSemi-structured interviews were conducted with 83 nurses, pediatricians, oncologists, and intensive care clinicians who had recently participated in a patient deterioration event at two pediatric oncology hospitals of different resource-levels: St. Jude Children’s Research Hospital (N = 42 participants) in Memphis, Tennessee or Unidad Nacional de Oncología Pediátrica (N = 41 participants) in Guatemala City, Guatemala. Interviews were conducted in the participants’ native language (English or Spanish), transcribed, and translated into English. Each transcript was coded by two researchers and analyzed for thematic content.ResultsEmotions around patient deterioration including concern, fear, and frustration were reported across all disciplines at both hospitals. Concern was often triggered by an elevated PEWS score and usually resulted in increased attention, which reassured bedside clinicians that patients were receiving necessary interventions. However, persistently elevated PEWS scores, particularly at St. Jude Children’s Research Hospital, occasionally resulted in a false sense of relief, diminishing clinician attention and negatively impacting patient care. Nurses at both institutions described how PEWS amplified their voices, engendering confidence and empowerment, two of the only positive emotions described in the study.ConclusionClinicians experienced a range of emotions while caring for high-risk patients in the setting of clinical deterioration. These emotions have the potential to contribute to compassion fatigue and burnout, or to resilience. Acknowledgment and further investigation of the complex interplay between PEWS and clinician emotions are necessary to maximize the impact of PEWS on patient safety while simultaneously supporting staff wellbeing.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Clinician Emotions Surrounding Pediatric Oncology Patient Deterioration

et al. 2021

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“…St. Jude and UNOP were chosen due to their similar patient volume, size, and recent PEWS implementation ( 5 , 11 ). In both hospitals, the PEWS scoring tool comprises vital signs, physical exam, treatment requirements, and staff and family concern paired with a response algorithm that defines the next steps in patient care ( Supplemental Figures 1 and 2 ).…”

Section: Methodsmentioning

confidence: 99%

Impact of PEWS on Perceived Quality of Care During Deterioration in Children With Cancer Hospitalized in Different Resource-Settings

et al. 2021

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BackgroundChildren with cancer are at high risk for clinical deterioration and subsequent mortality. Pediatric Early Warning Systems (PEWS) have proven to reduce the frequency of clinical deterioration in hospitalized patients. This qualitative study evaluates provider perspectives on the impact of PEWS on quality of care during deterioration events in a high-resource and a resource-limited setting.MethodsWe conducted semi-structured interviews with 83 healthcare staff (nurses, pediatricians, oncology fellows, and intensivists) involved in recent deterioration events at two pediatric oncology hospitals of different resource levels: St. Jude Children’s Research Hospital (SJCRH; n = 42) and Unidad Nacional de Oncología Pediátrica (UNOP; n = 41). Interviews were conducted in the participant’s native language (English or Spanish), translated into English, and transcribed. Transcripts were coded and analyzed inductively.ResultsProviders discussed both positive and negative perspectives of clinical deterioration events. Content analysis revealed “teamwork,” “experience with deterioration,” “early awareness,” and “effective communication” as themes associated with positive perception of events, which contributed to patient safety. Negative themes included “lack of communication,” “inexperience with deterioration,” “challenges with technology”, “limited material resources,” “false positive score,” and “objective tool.” Participants representing all disciplines across both institutions shared similar positive opinions. Negative opinions, however, differed between the two institutions, with providers at UNOP highlighting limited resources while those at SJCRH expressing concerns about technology misuse.ConclusionProviders that care for children with cancer find PEWS valuable to improve the quality of hospital care, regardless of hospital resource-level. Identified challenges, including inadequate critical care resources and challenges with technology, differ by hospital resource-level. These findings build on growing data demonstrating the positive impact of PEWS on quality of care and encourage wide dissemination of PEWS in clinical practice.

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“…The hospitals have similar missions, patient populations, and patient volume, and underwent a parallel process of PEWS implementation. 12 , 17 …”

Section: Methodsmentioning

confidence: 99%

Qualitative Study of Pediatric Early Warning Systems’ Impact on Interdisciplinary Communication in Two Pediatric Oncology Hospitals With Varying Resources

Graetz

Kaye

Garza

et al. 2020

JCO Global Oncology

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PURPOSE Hospitalized pediatric oncology patients are at high risk of deterioration and require frequent interdisciplinary communication to deliver high-quality care. Pediatric early warning systems (PEWS) are used by hospitals to reduce deterioration, but it is unknown how these systems affect communication about patient care in high- and limited-resource pediatric oncology settings. METHODS This qualitative study included semistructured interviews describing PEWS and subsequent team communication at 2 pediatric cancer centers, 1 in the United States and 1 in Guatemala. Participants included nurses, and frontline and intensive care providers who experienced recent deterioration events. Transcripts were coded and analyzed inductively using MAXQDA software. RESULTS The study included 41 providers in Guatemala and 42 providers in the United States (33 nurses, 30 ward providers, and 20 pediatric intensive care providers). Major themes identified include “hierarchy,” “empowerment,” “quality and method of communication,” and “trigger.” All providers described underlying medical hierarchies affecting the quality of communication regarding patient deterioration events and identified PEWS as empowering. Participants from the United States described the algorithmic approach to care and technology associated with PEWS contributing to impaired clinical judgement and a lack of communication. In both settings, PEWS sparked interdisciplinary communication and inspired action. CONCLUSION PEWS enhance interdisciplinary communication in high- and limited-resource study settings by empowering bedside providers. Traditional hierarchies contributed to negative communication and, in well-resourced settings, technology and automation resulted in lack of communication. Understanding contextual elements is integral to optimizing PEWS and improving pediatric oncology outcomes in hospitals of all resource levels.

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Impact of Implementing a Pediatric Early Warning System (PEWS) in a Pediatric Oncology Hospital

Cited by 9 publications

References 1 publication

Clinician Emotions Surrounding Pediatric Oncology Patient Deterioration

Clinician Emotions Surrounding Pediatric Oncology Patient Deterioration

Impact of PEWS on Perceived Quality of Care During Deterioration in Children With Cancer Hospitalized in Different Resource-Settings

Qualitative Study of Pediatric Early Warning Systems’ Impact on Interdisciplinary Communication in Two Pediatric Oncology Hospitals With Varying Resources

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