PEWS: Pediatric Early Warning Signs, Rapid Response Team, Code Blue

Transcription

1 PEWS: Pediatric Early Warning Signs, Rapid Response Team, Code Blue Royanne Lichliter BS, RN And Jodi Thrasher MS, CFNP, RN 2/4/09

2 You Could Be A Lifesaver TOO!! 2

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, 8 th 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. 3

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 4

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. Page 5

6 SBAR Situation, Background, Assessment, Recommendation

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? Page 7

8 The PEWS Tool

9 Pediatric Early Warning Signs: PEWS Behavior Cardiovascular Respiratory Playing Alert Appropriate At baseline Score Pink Capillary refill 1-2 seconds Within normal parameters No retractions Sleep Fussy but consolable Pale Capillary refill 3 seconds Greater than 10 above normal parameters Use of accessory muscles 30+% FiO2 3+ Liters/minute Irritable/Inconsolable Grey Capillary refill 4 seconds Tachycardia of 20 above normal rate Greater than 20 above normal parameters Retractions 40+% FiO2 6+ Liters/minute Trach &ventilator dependent Lethargic Confused Reduced response to pain Grey Mottled Capillary refill 5 seconds or above Tachycardia of 30 above normal rate or bradycardia. 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 9

10 Pews Flowchart Families often know their child best. Please remember to listen to their concerns and advocate for them. P t admitted to inpatient unit Pt assessed/ reassessed by RN including PEW S score PEWS Score 0-2 P EWS Score Totaling 3 Individual PEWS score of 3 in any category PEW S Score 4 PEW S S core 5 Reassess and rescore at next routine assessment Notify resident/ intern and charge RN of clinical change Notify charge RN, resident /intern, supervising res ident Notify charge RN, resident /intern, supervising resident, nursing supervisor and attending Plan and collaborate with entire health care team. Plan and collaborate with entire health care team. Plan and collaborate with entire health care team. Document and determine time of next assessment and rescoring If still concerned notify attending and nursing supervisor and consider RRT eval x75555 RRT eval X75555 Notify supervising resident / attending Document and reassess after intervention. Plan and collaborate with entire health care team. Page 10

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 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 Page 11

12 Rapid Response Team

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 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 Page 13