Paediatric Early Warning Score Clinical Guideline

Transcription

1 Paediatric Early Warning Score Clinical Guideline All healthcare professionals must exercise their own professional judgement when using guidelines. However any decision to vary from the guideline should be documented in the patient records to include the reason for variance and the subsequent action taken. Version: Final Version Ratified by (name of Committee): Provider Quality and Safety Committee Date ratified: October 2010 Date issued: February 2011 Expiry date: October 2013 (Document is not valid after this date) Review date: February 2013 Lead Executive/Director: Name of originator/author: Target audience: ` Vicky Preece, Associate Director of Nursing and Therapies Tony Kinsey, Senior Resuscitation Officer Health Care Professionals in Minor Injuries Units, Worcestershire PCT

2 CONTRIBUTION LIST Key individuals involved in developing the document Name Tony Kinsey Designation Senior Resuscitation Officer. Circulated to the following individuals for comments Name Ginny Snape Yvonne Rubbery Lin Ingles Lee Manning Jane Haffner, Phil Shakeshaft Kerry Fitzpatrick, Dr. David Lewis Dr. Doug Castling Dr. Andrew Short Mel Chippendale Sarah Chambers Della Lewis Carole Clive Sue Lunec Lesley Way Designation Matron, Tenbury Hospital. Sister, MIU Malvern Matron, Malvern Hospital Charge Nurse, MIU Malvern Sister, Sister, MIU Charge Nurse, MIU, POWCH. ENP, Sister, MIU Consultant Paediatrician, Worcestershire PCT. Consultant Paediatrician, Worcestershire Acute Trust Consultant Paediatrician, Worcestershire Acute Trust. Advanced Nurse Practitioner, Riverbank paediatrics, Worcestershire Acute Trust Sister, Riverbank paediatrics, Worcestershire Acute Trust Clinical Governance Manager, Worcestershire PCT Nurse Consultant, Infection Control, Worcestershire PCT Pharmacy Advisor, Worcestershire PCT Patient Safety Manager, Worcestershire PCT We would like to acknowledge the help of Worcestershire Acute Hospital Trust in producing these guidelines and thank them for their support. WPCT Paediatric Early Warning Score System Page 2 of 7

3 CONTENTS PAGE 1. Introduction 4 2. Use of Paediatric Early Warning Score (PEWS) 4 3. Audit of the use of this guideline 5 4. Dissemination and archiving of this guideline 5 5. References 5 Appendices Appendix 1 Supply details for Observation/PEWS charts 6 Appendix 2 Observations/PEWS chart for age 0 to 11 months Appendix 2 Observations/PEWS chart for age 1 to 5 years Appendix 3 Observations/PEWS chart for age 6 to 12 years WPCT Paediatric Early Warning Score System Page 3 of 7

4 1. Introduction. The Paediatric Early Warning Score (PEWS) is designed to enable health care professionals to recognize at risk children and to trigger early referral to medical staff, so that early intervention can help to prevent deterioration. It will help facilitate the early transfer of these children to an appropriate higher care facility e.g. General Practitioner; Accident and Emergency (A&E) department or when indicated and agreed to in-patient facilities. Early recognition and treatment of the seriously ill child is paramount in avoiding progression to cardio respiratory arrest and reducing mortality and morbidity. UK Resuscitation Council (2006) The PEWS outlined in this guideline is based on the system and charts developed by Worcestershire Acute Hospitals NHS Trust. Their agreement and support has been given for this adapted version to be used to assess children attending Worcestershire PCT Minor Injury Units (MIU s). 2. Use of Paediatric Early Warning Score Worcester Acute Hospitals have produced three charts and they each have age specific values on the back which are used to generate a PEWS score. The Charts are: 0-11months (to include children who are 0-11months and 364 days) 1yr-5yrs (to include children who are 1yr old- 5yrs and 364 days) 6yr-12yrs (to include children who are 6yr old- 12yrs and 364 days) Any child over 13yrs will have a PARS chart. The score is generated from six parameters: Heart Rate Respiratory Rate Conscious level Capillary Refill Temperature Systolic BP Each parameter has a score from 0-3. The score is generated from the cumulative total of all six parameters. The PEWS score should be calculated by using the chart on the reverse side of the Observations chart (see appendix one - three). A score is calculated by taking a full set of observations. The score is documented on the front of the PEWS chart. The higher the score the sicker the child. Health care professionals working in the Worcestershire PCT Minor Injury Units can use the PEWS scoring system and charts developed by the Acute Trust. For supply details please see appendix four. If an abnormal score is generated, then it is recommended that PCT staff consider using the advice below (and not the guidance on the rear of the Acute Trust observation charts which is aimed at Acute Trust staff in hospital locations). If a child is transferred form an MIU to the Acute Trust then the observation chart/pews score should accompany the child. Score 4 or above: Score 3: Score 1-2: Score 0: Ring (9) 999 for an emergency ambulance to transfer the patient. Ring A&E to advice of imminent transfer. Consider contacting Paediatrician on call for advice consider admission. As a minimum make urgent referral to GP/Out of hour s service. Consider urgent referral to GP/Out of hour s service in appropriate cases. Otherwise treat as clinically appropriate. Normal observations. Treat as clinically appropriate. WPCT Paediatric Early Warning Score System Page 4 of 7

5 Staff should note that a PEWS score of 1 or 2 may (for example) be generated by a child with a non serious infection, generating a pyrexia and an associated tachycardia. Hence the advice for this score says consider urgent referral etc. However, staff should contact medical staff for advice for any child whose condition is worrying even if they have a low or normal PEWS scores. Notes regarding transfer of patient to A&E: Staff should ring A&E to advise of transfer (include information on infection status if appropriate). The PCT Transfer and Record form for Medical Emergencies and Cardiac Arrests should be used to record the incident and for transferring information (details in Worcestershire PCT Resuscitation policy, 2009). The Observation/PEWS chart which has been commenced should go with the child. The guidance does not override the individual responsibilities of the health care professional to make appropriate decisions, according to the circumstances of the individual patient in consultation with the child and parent/carer. However, if the health care professional chooses to deviate from this guideline the reason for deviation and subsequent action taken must be documented. 3. Audit of the use of this guideline. The use of the PEWS score in guiding health care professionals to make emergency transfers will be monitored by the Trust Resuscitation Officers. All incidents should have the PEWS score recorded on the PCT Transfer and Record form for Medical Emergencies and Cardiac Arrest. The Trust Resuscitation Officers will include this in their annual report to the PCT. 4. Dissemination of this guideline and archiving of the previous guideline. The dissemination of this guideline is primarily via the Intranet and Internet. Previous guidelines are removed and archived as set out in the WPCT Archiving Policy. This guideline will be actively promoted by the Resuscitation Officers to Managers and Senior Clinicians within the trust who will, in turn, promote awareness of the guideline through team meetings. Where paper copies of the guideline are disseminated to staff, confirmation of receipt is required. In these instances, staff will be clearly informed in writing which outdated paper documents should be removed and destroyed, and which document replaces them. Staff are strongly discouraged from printing off or photocopying procedural documents and should understand that the internet version of the guideline is the definitive version. 5. References. Patient At Risk Score guideline Worcestershire PCT Resuscitation Policy Worcestershire PCT UK Resuscitation Council, European Paediatric Life Support manual. Second Edition. Paediatric Monitoring and Observation Guideline Worcestershire Acute Hospitals NHS Trust. WPCT Paediatric Early Warning Score System Page 5 of 7

6 Appendix One: Supply details for Observation/PEWS charts The Observation/PEWS charts are produced and supplied by Service Point, who are based at Worcestershire Royal Hospital. Service Point telephone number is Order codes are: Age 0-11 months: order code is 1758 Age 1 5 years: order code is 1759 Age 6-12 years: order code is 1760 WPCT Paediatric Early Warning Score System Page 6 of 7

7 Equality Impact Assessment Report Template Your Equality Impact Assessment Report should demonstrate what you do (or will do) to make sure that your function/policy is accessible to different people and communities, not just that it can, in theory, be used by anyone. 1. Name of policy or function PEWS (Paediatric Early Warning Score) 2. Responsible Manager Tony Kinsey, Senior Resuscitation Training Officer 3. Date EIA completed April Description of aims of function/policy To provide a clinical assessment for children who present at the Minor Injuries Unit. 5. Brief summary of research and relevant data These guidelines are taken from the Worcestershire Acute Hospitals Trust. 6. Methods and outcomes of consultation Consultation with MIU staff and 7. Results of Initial Screening or Full Equality Impact Assessment Initial or Full Equality Impact Assessment? Equality Group Race Gender Disability Age Sexual Orientation Religion or Belief Human Rights Assessment of Impact 8. Decisions and or recommendations (including supporting rationale) 9. Equality action plan (if required) 10. Monitoring and review arrangements (include date of next full review) Department Clinical Governance Directorate Professional Development Director Vicky Preece Report produced by and Tony Kinsey, Senior Resuscitation Officer job title Date report produced April 2010 Date report published February 2011 WPCT Paediatric Early Warning Score System Page 7 of 7