Table 8 Themes of perceived positive and negative impacts of PEWS in ED on pediatric practice
Themes | Sub-themes | Quotes |
|---|---|---|
Perceived positive impacts | ||
Identification | • Prompts earlier recognition of risk, change, decline, and abnormality • Increases provider’s general awareness of risk, concern, and abnormality • Guides triage decisions | “With the PEWS scores that I gathered after assessment, it helped me alert the primary nurse and emergency doctors to see patient as soon as possible and be able to render care in a timely manner.”- Nurse |
Assessment | • Provides a standardized assessment framework • Improves ease and comprehensiveness of assessment (full vital signs) • Increases staff comfort with vital signs norms | “Caring for a pediatric patient can be very stressful for some nurses, the flowsheet helps guide the inexperienced nurse through a very thorough assessment.”- Nurse |
Monitoring | • Provides a baseline for monitoring from triage onwards • Increases frequency of vital signs assessment and closer observation • Improves ability to trend across patient stay which helps with care and disposition decisions | “Children get vitals more often and all of their vitals more often! It is easy to see what vitals are normal and what are not with graphs and colours. It is easy to see changes and trends in vitals. It likely prompts more repeat vitals and assessments and documentation thereof. When done at triage prompts full vitals early.”- Physician |
Communication | • Provides a standardized approach to communication (speaking the same language) • Promotes earlier notification of physicians • Enhances delivery of thorough information to physicians • Improves confidence of nurses with notification (validation by score) | “Effective as a means of communicating with doctors, helpful in confirming if patient is improving as appearance can be deceiving, PEWS assists with confirmation.”- Nurse |
Mitigation | • Provides a standardized approach to escalation • Supports earlier response as notification occurs faster | “I think it is very important data when it comes to assessment, priority setting and rendering time sensitive actions to every peds patient.”- Nurse |
Other | • Promotes better overall care for pediatric patients | “PEWS has really played a huge role in the way in which we care for and treat our pediatric patients. This has been a real positive change.”-Nurse |
Perceived negative impacts | ||
Accuracy | • Scores may not accurately capture clinical status in some instances (e.g. false positive scores due to upset, post medication) | “Need to alert staff that PEWS can be elevated due to patient stress in ED environment/circumstances, crying, tantrum, etc. Thus, require a strategy for these circumstances i.e. using clinical judgment, repeating scoring when patient calms.” - Nurse Educator |
Autonomy | • Standardized scoring and escalation can take away from clinical judgement | “In my experience as charge nurse, we use clinical judgment, vital signs anyways, and the PEWS is just a numerical value of our own clinical assessment.” - Nurse |
Workload | • Can increase time for assessment (particularly at triage) | “Added paperwork and time spent especially at triage” - Nurse |
Lack of tailoring to ED setting | • Increases paperwork because poorly integrated with current ED paperwork (double charting) • Form is missing important information for ED (e.g. narrative space, medication record) | “Increased charting as not everything can be charted on one paper” - Nurse |
Relevance | • Lacks relevance or seems excessive for patients with single system or minor injuries | “It seems too time consuming and unnecessary to do for all children presenting in the ED. There are a lot of very simple presentations that do not seem to warrant the full set of vitals and score. For example, children coming in with very small lacerations or simple wounds, or even simple injuries.” - Nurse |