ISQUA17-3305DEVELOPING AND IMPLEMENTING A NATIONAL PAEDIATRIC EARLY WARNING SYSTEM FOR MANAGING CHILD CLINICAL DETERIORATION

Abstract

Objectives: A 2013 patient safety review by the Irish Health Information and Quality Authority identified several care deficiencies including a failure to act or escalate concerns about deterioration to appropriately qualified clinicians. The Minister for Health subsequently mandated the Department of Health's National Clinical Effectiveness Committee commission and quality assure a number of National Clinical Guidelines; including early warning scores for adult, maternity and paediatric healthcare settings. This lead to the establishment of an Irish Paediatric Early Warning System (IPEWS) steering committee and appointment of a national PEWS coordinator with the remit of developing, and rolling-out, a national Clinical Guideline for PEWS which consisted of a number of components and phased initiatives. 1. To develop a single, national IPEWS, associated guideline document underpinned by best available evidence and targeted training programme 2. To support implementation of the IPEWS nationally in all inpatient paediatric hospital sites Methods: The process of developing and implementing the Irish national PEWS Clinical Guideline has been iterative and dynamic with use of multiple phases and methods, including beta Conduct of a systematic literature review on PEWS beta Development of age-appropriate PEWS scoring tools and observation charts beta Development of a PEWS education/training programme beta Pilot evaluation of PEWS in four settings beta Redesign of PEWS scoring tools/observation charts with involvement of human factors experts beta Development of a suite of PEWS parent communication resources beta Baseline evaluation of hospital safety culture before national PEWS implementation beta Consultation for improving safe use of modifications within the scoring system beta Development of a national standard for ongoing multidisciplinary training beta Development of an electronic audit tool linked to nationally reportable key performance indicators Results: The National Clinical Guideline no.12 PEWS was endorsed by the Irish Minister for Health in 2015 (updated November 2016) to provide the framework for implementation of the Irish PEWS. Now, in early 2017, PEWS has been implemented in 32 hospitals in the public sector and a number of private hospitals, following a centrally-coordinated, regionally-facilitated "Train the Trainer" programme with ongoing support from the National PEWS Coordinator and PEWS Steering Group. Valuable lessons have been learned throughout the process and several critical success factors identified; governance support for key local leads and champions, strong and ongoing training programme, frequent audit for quality improvement, frontline ownership of the change and a supportive, collaborative, multidisciplinary team culture at local level. Conclusion(s): There has been an emphasis on the requirement of a systems approach to enhance the multifaceted elements of a successful early warning system; including implementation with quality improvement methods, standardisation and improved individual and team situation awareness that has been identified as a critical success factor in preventing inpatient deterioration. The Irish PEWS continues to evolve over time and with experience. We view IPEWS as a foundational paediatric safety programme which will take time to embed and reach full potential. Work is required to examine the national impact of the system on paediatric clinical outcomes and on hospital safety culture and staff working practices.