The Science Journal of the American Association for Respiratory Care

2012 OPEN FORUM Abstracts


Kathy L. Kammeraad, Doug Campbell; Respiratory Care, Spectrum Health, Grand Rapids, MI

Background The goal of PEWS and AWARE was to recognize patients in the early stages of deterioration and prevent progression to respiratory or cardiac arrest.Despite implementing a Rapid Response Team in 2006, many children still required emergent interventions on general units. Through analysis, it became clear that staff were unable to identify early deterioration and language was needed to allow communication of concerns without feeling intimidated by expert level practitioners. Method PEWS was developed using an age-based scoring tool derived from clinical variables most predictive of physiologic deterioration. This technology tool was built into the electronic medrecord so that a precise score could be recorded for each patient. Data is displayed in real time, on an electronic whiteboard viewable throughout the unit. Clinicians can see at a glance which children are most at risk. The team then developed a series of algorithms with prescribed actions for nurses to follow based on the PEWS score. An AWARE (Advanced Warning and Response Event) team evaluates each child whose score indicates that the child is at higher risk of sudden deterioration. The AWARE team is comprised of the bedside RN, a pediatric critical care RN, a resident physician, a respiratory therapist and a clinical service coordinator. Each team member has a defined role in providing assessment, stabilization and interventions. Results Using the PEWs scoring system as identification, and the AWARE as a standardized approach to activate expert level assessments, HDVCH has reduced emergent events on the general units. 23 cardiopulmonary resuscitations took place in the 24 months prior to implementation of these programs, as compared to 4 in the 9 months post implementation, resulting in a 53.6% reduction. These new processes have resulted in earlier transfer to PICU when indicated and a decreased severity of illness for unplanned PICU admissions. Conclusion The PEWS and AWARE team serve as the foundation for a common understanding and language among disciplines, allowing staff to clearly communicate concerns about their patient and to seek help without fear of intimidation. Earlier identification of patients at risk, coupled by prompt interventions has increased patient safety and significantly reduced sudden, life-threatening events in children. These processes may be replicated with other populations on general medical and surgical units within other health systems. Sponsored Research - None