LAUSR

Paediatric Early Warning Systems (PEWS) aid timely recognition and response to a deteriorating child. In 2015 we identified that existing charts had substantial variability in use. Datix reporting and child death review panels identified avoidable harms resulting from inadequate monitoring and escalation. Aims We aimed to design and implement a new PEWS following Kotter’s 8-step change model to ensure inpatients have regular observations and an initial PEWS score within an hour of admission. Methods The new PEWS charts were developed following focus groups with multidisciplinary staff. We sought management level support under the national ‘Sign up to Safety’ initiative. A regional forum was developed with the involvement of the Young People’s Advisory Group and parents. Changes included a new minimum set of observations, parental concern, colour coded scoring and escalation system. The charts were piloted initially in December 2015, and fully implemented to all paediatric wards in May 2016. Changes were tested using multiple PDSA cycles. Bimonthly audits were undertaken by the Clinical Governance and Risk Department (CGARD). An education strategy included face-to-face teaching by designated PEWS champions, an e-learning module and in-situ simulation based teaching. Results Audits demonstrated sustained improvement and compliance from December 2015 to June 2017 (table 1). Improvements were seen in measures including blood pressure and our new parental concern score. Conclusion Sustained change has occurred through adaption and flexibility. The new chart is used across different local and regional sites, including intensive care. Abstract G406(P) Table 1 Observations Pre implementation Post implementation Aug-15 Dec-15 Aug-16 Dec-16 Jun-17 Parental Concern 52.63% 58.33% 69.23% 80.0% Blood Pressure 48.86% 52.63% 69.44% 69.23% 79.0% All observations recorded 20.45% 5.26% 26.39% 44.23% 51.0% Success was due to dedicated champions and senior nursing staff with support from the CGARD. Parents played a definitive role in shaping our work. Lessons included the need to develop a champions’ network earlier and more frequent audit and feedback. We aim to develop an electronic score, continue to evaluate the escalation pathways and review unplanned PICU admissions.