Paediatric Nursing Orientation

Bedside Paediatric Early

Warning System
 Objectives

Describe the Pediatric Early warning

System

Review the background of the PEWS

Demonstrate how to use Bedside PEWS

 Definition

Pediatric Early Warning System is

a severity of illness score to detect evolving

critical illness in hospitalized children

Parshuram, et al. 2011

 Background

2004 Chart review of patients with near or actual

cardiac arrest

2007 BPEWS record developed

2008 Clinical testing of BPEWs record (40RNs)
2009 Pilot study conducted- Credit Valley
2011 Multi-site randomized clinical trial (SickKids-
control group

2014 Phased in at SickKids

 System of Care

picks up subtle changes over time

enables picks thinking
critical up subtle changes over
time
timely utilization of resources
enables critical thinking
encourages changes
timely in current
utilization practice
of resources
commonlanguage
encourages changes in
current practice
common language
 How to use the Documentation Record

Five separate
< 3m
newborn to less

forms
than 3 months

3 months and older

but younger
s than
Representing 5 3-12m firt b irthday

age groups 1-<5yr 1year and younger

than 5th birthday

Physiologic 5th birthday and

5-<12yr younger 12th
birthday
differences 12th birthday and
>12yr older
 Indicators used for PEWs scoring

1. heart rate
2. respiratory rate
3. systolic blood
pressure
4. oxygen saturation
5. oxygen + method
6. respiratory effort
7. capillary refill
 Scoring

Use colour key to

subscore each
indicator to
calculate PEWs
Graphing on PEWs document
Graphing Example
Score Matched Care recommendation
 What else is new?

Mixed column

Three columns for elimination:

urine
stool
mixed

A diaper/brief that contains both urine and stool and it

is unclear if there is pure urine or pure stool. For
example the stool is not formed and cant be
removed.
 Mixed Column

Eliminates the practice of inaccurate urine output

assessment

Prevent harm and death due to underestimating

potential or actual dehydration
More than just a score

Pulls together multiple concerns into one number

Helps staff quantify a gut feeling

Gives nurses permission to speak up sooner than

they might otherwise

Empowers staff at the bedside to make requests

for physician assessment and interventions

Common language to communicate concerns

 Bedside PEWS Video link

https://www.youtube.com/watch
?v=kOmPR6YocG4