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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