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