Noticing when a hospitalized child’s health is severely weakening before the patient’s lungs or heart stop working – known as a cardiopulmonary arrest or code – can mean the difference between life and death.
To improve our caregivers’ ability to recognize when a patient’s vital signs are getting worse as early as possible and provide more time for an intervention if needed, Children’s Hospital implemented a new approach. The process focuses on identifying the child’s failing status up to 24 hours prior to the child having a code, and is designed to help eliminate preventable codes.
Children’s adopted the process, called Pediatric Early Warning System Score (PEWSS), as part of a larger effort to enhance identification and treatment of patients whose condition is deteriorating, and standardize communication among caregivers to provide the best care for our kids.
This is especially important since about 7 percent to 14 percent of cardiopulmonary arrests occur in acute care, according to medical literature. Unfortunately, only 10 percent of those patients affected remain alive and neurologically unharmed one year following their cardiopulmonary arrest.
Just one year after implementing PEWSS, Children’s is already seeing dramatic improvements. In 2011 we reduced our average of 30 acute care codes a year to 12, and as a result the number of deaths dropped 68 percent. There were 14 fewer deaths related to an emergency response or unplanned transfer to intensive care – meaning 14 fewer families suffered the devastating loss of a child.
“We’re saving kids,” said Beverly Hayden-Pugh, Children’s vice president and chief nursing officer. “These are remarkable results.”
More complex patients in acute care
Due to advanced technology and enhanced quality of care, many pediatric patients previously seen in intensive care are now cared for on the floor. “Our patients in acute care units are much more complex,” said Mary-Ann Robson, a registered nurse and clinical education specialist, who spearheaded the PEWSS effort at Children’s. “In 2010, 36 percent of our cardiopulmonary arrests were in acute care, prompting us to identify this as the most significant area of harm for our children.”
After researching several pediatric tools to help us reverse this trend, we selected PEWSS, adapted it to our needs and provided caregiver education. In fall 2010 we began rolling out the new process in phases. By January we incorporated the system into inpatient units hospital-wide that care for children with a broad spectrum of serious and often life-threatening conditions, from infectious disease, cancer, heart and gastroenterological issues to those who underwent surgery and/or need to be on respirators.
“Most pediatric codes are related to respiratory problems or shock,” said Robson. “Both of these causes are potentially reversible if identified early enough.”
Better, safer care
We experienced another success with the new system – we went as long as 58 days with no acute care codes in 2011. We also decreased our rate of acute care codes from 0.64 per 1,000 patient days in 2010, to 0.24 per 1,000 patient days in 2011, even when acute care had about 4,000 more patient days in 2011.
“According to CHCA (Child Health Corporation of America) data, we went from being in the lowest quartile to a hair’s breadth away from the top quartile – in one year,” said Robson. “This means better, safer care for our children.”