Post on 15-Oct-2020
Pediatric Ramathibodi Early Warning System
Somporn Poolpanitoopatum, HN
Department of Pediatrics, Ramathibodi Hospital
Mahidol University, Thailand
Background
Ramathibodi hospital launched a policy to follow WHO recommendation on patient safety goal
Safe surgeryInfectious controlMedication safetyPatient care processLine, tube, catheterEmergency response
Emergency response
•Response to the deteriorating patient
• Lack of uniform evaluation tool to identify at-risk patients before deterioration
• Increasing number of unplanned admission to pediatric intensive care unit and code event
•Need skill and experience of care provider for early detection and prompt activation of care team
RRT for Unstable pt.
ตอนท III-4 การดแลผปวย (PCD)(III-4.1 การดแลทวไป และ III-4.2 การดแลผปวยและการใหบรการทมความเสยงสง)- ทมผใหบรการสรางความมนใจวาจะใหการดแลผปวยอยางทนทวงท ปลอดภย เหมาะสม และเปนไปตามมาตรฐานวชาชพ- มระบบเฝาระวงการเปลยนแปลงอยางเหมาะสมกบความรนแรงของความเจบปวยและด าเนนการแกไขหรอปรบเปลยนแผนการรกษาไดทนทวงท
AHA
Ramathibodi Rapid Response Systems
Identification
- Physiological (Early Warning score, REWs)- Clinical sings (Early Warning sings,RCWs)
Serious adverse events can be prevented by recognizing and responding to Early signs of clinical and physiological deterioration
(RRRS)
Trigger tool
Define : Low, Moderate, High risk patients
Rapid Response Team/System
Response
CPR
Goal of RRS
• To respond rapidly to patients outside of critical care areas when their clinical condition adversely changes- Closed monitoring - Early intervention - Early treatment- Early ICU transfer (Time)
• Decrease adverse events
Rapid Response System
Patient outcome (KPI)- In hospital mortality - CPR rate - ICU admission - Time to ICU transfer- Unplanned ICU admission - LOS- NR - Dead
Multidisciplinary Team
Development of Pediatric Ramathibodi
Early Warning System (PREWS)
Pediatric Ramathibodi Early Warning System (PREWS)
Plan
• Set up goals
• Build up a team leader
• Developing warning score module
Goal
•Reduce rate of unplanned critical care unit transfer (timely manner)
•Early identify patient who has subtle changes in clinical signs before deterioration
•Prevention of code blue event in pediatric regular ward
Build up a team leader
รศ.นพ.ณฐชย อนนตสทธ
ผศ.นพ.พฤหส พงษม
พว.สมหญง กลฑล
พว.สมพร พลพานชอปถมย
Many different titles….
Pediatric Ramathibodi Early Warning System (PREWS)
The PREWs Tools(Pediatric Ramathibodi Early Warning Score)
•Variation in age-specific thresholds for normal and abnormal physiology
•Children’s inability or difficulty to articulate how or what they feel
•Children’s ability for early physiological compensation
•Need for greater focus on respiratory deterioration in children
PREWs tool
Developing of warning score module
Adapted form NHS Institute for Innovation &Improvent,England
1. Concern
2. Heart rate
3. Systolic blood pressure
4. Respiratory rate
5. Respiratory Distress
6. Respiratory support
7. Level of consciousness
8. Central capillary refill time
Score 0-1 for each parameters
Core PREWs parameters
Pediatric Ramathibodi Early Warning System (PREWS)
Do
• Group education
• Pilot implementation of early warning scores
Group education
- All pediatric RN and PN (100%)
- Pediatric ward staffs and residents
Pilot implementation of early warning scores
• Implement of modified early warning scores
•Record scores every 4 hours
•Review of all transferred cases to critical care unit
Pediatric Ramathibodi Early Warning System (PREWS)
Check• Evaluation of warning
scores performance
Evaluation of warning scores performance
•Scores for each domain is unable to provide enough detail of patient severity (score 0, 1) (underestimate)
• Increase workload and redundant work (incomplete evaluation for each parameters)
• Less concern about total scoring and causing inadequate trigger response team
Pediatric Ramathibodi Early Warning System (PREWS)
Act• Improve performance of
PREWs
Core Parameters
2.Oxygen saturation
1.Respiratory rate
3.Temperature
4.Systolic blood pressure
5.Heart rate
6.Level of consciousness
7.Capillary refill time Pediatric
• A variety of vital signs monitoring tools designed to track signs of deterioration and trigger a rapid response to improve patient safety.
• Facilitate recognition of abnormal physiological parameters in deteriorating patients, alerting ward staff to the need for intervention.
Additional Parameters
Early Warning Score
Pediatric Ramathibodi Early Warning Score
1. 0-1 month
2. 1+ month - 1 years
3. 1+ year - 5 years
4. 5+ years - 12 years
5. 12+ years
PREWs
Pediatric Early Warning Scoring
6:Parameters
Pediatric Early Warning Scoring
Pediatric Early Warning Scoring
Pediatric Early Warning Scoring
Ramathibodi Rapid Response Systems
Identification
- Physiological (Early Warning score, REWs)- Clinical sings (Early Warning sings,RCWs)
Serious adverse events can be prevented by recognizing and responding to Early signs of clinical and physiological deterioration
(RRRS)
Trigger tool
Define : Low, Moderate, High risk patients
Rapid Response Team/System
Response
CPR
Ramathibodi Clinical Warning Signs:
Department of pediatric
•Newborn- Necrotizing Enterocolitis (NEC) การดแลรกษาภาวะล าไสอกเสบเนาตายในทารกแรกเกด
- Persistent Pulmonary Hypertension of the Newborn (PPHN) :
การดแลรกษาภาวะความดนเลอดในปอดสงในทารกแรกเกด
•Pediatric
- Pediatric Septic Shock (อายมากกวา 1 เดอน - 18ป)
s
Ramathibodi Rapid Response Systems
Identification
- Physiological (Early Warning score, REWs)- Clinical sings (Early Warning sings,RCWs)
Serious adverse events can be prevented by recognizing and responding to Early signs of clinical and physiological deterioration
(RRRS)
Trigger tool
Define : Low, Moderate, High risk patients
Rapid Response Team/System
Response
CPR
Thank you for your attention