meeting proceedings

Successful Implementation of a Pediatric Early

Warning Score in a Resource-Limited Pediatric
Oncology Hospital in Guatemala
Abstract 25

Background: Hospitalized pediatric oncology patients are at high risk for clinical decline and mortality,
particularly in resource-limited settings. Pediatric Early Warning Scores (PEWS) are commonly used to
aid with early identification of clinical deterioration; however, these scores have never been studied in
oncology patients in low-resource settings. We describe the successful implementation of a modified
PEWS at Unidad Nacional de Oncologı́a Pediátrica (UNOP), a national pediatric oncology hospital in
Guatemala.

Methods: The PEWS used at Boston Children’s Hospital (BCH) was modified through key informant
meetings at UNOP, adjusting for practice variations between the two hospitals. After an initial pilot of the
tool, the PEWS was implemented in all non-ICU inpatient areas at UNOP (60 beds with about 2,000
admissions/year). During implementation, systems were created to monitor errors in calculating PEWS,
patient transfers to a higher level of care, and high PEWS scores for ongoing quality improvement.

Results: Hospital-wide implementation occurred over 6 months, when 113 nurses were trained in the
PEWS tool and algorithm. Compliance with PEWS performance and documentation was 100% by the
end of the implementation period, with 300 to 400 PEWS measured daily and less than 10% errors.
Monitoring of PEWS results reports an average of 5 high PEWS per week with 30% transferring to a higher
level of care. Among patients requiring ICU transfer, 86% had an abnormal PEWS prior to transfer, which
is similar to results at BCH (90%). Staff surveys showed a high degree of satisfaction with PEWS (4.6/5)
and minimal difficulty using the score (2.3/5) (n567).

Conclusions: We describe the successful implementation of a PEWS in a pediatric oncology hospital in

Guatemala. This work demonstrates that PEWS is a feasible, well-accepted, and low-cost quality im-
provement measure in this resource-limited setting. We now plan to evaluate the effects of this
implementation on patient care and outcomes.
Asya Agulnik AUTHORS’ DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST:
Dora Judith No COIs from the authors.
Soberanis Vasquez
Jose Emigdio Garcı́a Ortiz Asya Agulnik and Monica Kleinman, Division of Critical Care Medicine, Department of Anesthesia, Perioperative and Pain Medicine,
Boston Children’s Hospital, Boston, MA; Dora Judith Soberanis Vasquez, Jose Emigdio Garcı́a Ortiz, Lupe Nataly Mora Robles, Ricardo Mack,
Lupe Nataly Mora Robles
and Federico Antillón, Unidad Nacional de Oncologı́a Pediátrica, Guatemala City, Guatemala; and Carlos Rodriguez-Galindo, Department
Ricardo Mack of Global Pediatric Medicine, St Jude Children’s Research Hospital, Memphis, TN

Federico Antillón Corresponding author: Asya Agulnik, Boston Children’s Hospital, Division of Critical Care Medicine, Bader 634, 300 Longwood
Monica Kleinman Ave, Boston, MA 02115; 617-355-7327; asya.agulnik@childrens.harvard.edu

Carlos Rodriguez-Galindo DOI: 10.1200/JGO.2016.003871

60s jgo.ascopubs.org JGO – Journal of Global Oncology

© 2016 by American Society of Clinical Oncology Licensed under the Creative Commons Attribution 4.0 License
Downloaded from ascopubs.org by 181.64.122.172 on October 12, 2019 from 181.064.122.172
Copyright © 2019 American Society of Clinical Oncology. All rights reserved.