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Is there evidence of an effect?-
Paper 1 - yes
Paper 2 - No

How will you implement this?

Not enough evidence!!
Concerned to opposing views
Paper 1 was methodical and very confident in their answer
Paper 2 - were uncertain of the validity and generalisability
More research needs done
Hard thing to track - all dependent on patient
(paper 3 - rejected - adult - found difference with PEWS)

How will you monitor if it works?
Record more results
Take on board what papers have said and develop independent review based on paper's method.

What barriers do you think there will be to implementing a change and how might you pre-empt and address these?
Nurses reluctant to change -
One person job is practically impossible - need team - higher up people who are willing to engage with you.
Fear of needing to find an alternative if PEWS isn't sufficient -

Think about time challenges, communication problems, colleagues resistant to change, institutional barriers.
No one likes change - lack of time - negative outlook
Communication prob - between interdisciplinary team
Patient observation needs to be more than just the PEWS score - look, listen feel etc...

Is the evidence not strong enough to support an answer?
PEWS is helpful but not definitive.
Human bodies are individualistic on how they react to disease etc.
More needs to be done than a PEWS score - look listen feel
It's a good indication
but is subject to human error

# data[].attributes.body
Multicentre validation of the bedside paediatric early warning system score: a severity of illness score to detect evolving critical illness in hospitalised children

Strengths

Is consistent throughout

Answers the initial question

Has consistent data

Uses big sample size in various hospitals - this improves applicability

Use a frequency-matched case-control study

Had a control

Prospective study

Uses nurses' experiences and medical notes

Able to graph results

Weaknesses

Control was chosen during study – this could cause there to be an unequal amount of control to testing patients.

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Effect of a Pediatric Early Warning System on All-Cause Mortality in Hospitalized Pediatric Patients

Strengths

The article shows findings that the implementation of the Bedside PEWS compared with usual care did not significantly decrease all-cause mortality among hospitalized pediatric patients which answers our chosen question showing that the use PEWS charts do not affect nurses being able to identify a deteriorating patient.

It is a randomized trial of 21 hospitals in 7 countries including UK and the south of Ireland making it applicable to NI

It was carried out on paediatric patients from gestational age to 18 years, giving a variety of age ranges.

Its secondary outcome is a significant clinical deterioration event which relates to out chosen question

Good ethical research as it gained informed written consent from patients to be involved in the study

Carried out over 52 weeks

Started off with a baseline of 5.1 deaths per 1000 hospital discharges

P value= 0.05, regarded as significant

Cluster randomized design

Large sample trial

Weaknesses

The article does not support the use of Pediatric Early Warning System to reduce mortality rates within hospitals. This may be a weakness as this is the system we use here in NI to detect the condition of a patient and severity of illness according to saturations and BP etc.

It focuses specifically on cardiopulmonary arrest

34 hospitals were enrolled in this study only 23 met the criteria and only 21 participated.

Uncertainty around validity and generalizability.

# data[].attributes.body
Optimising paediatric afferent component early warning systems: a hermeneutic systematic literature review and model development

Strengths

Uses 82 studies, therefore large quantity of data would be gathered.

Answers the question

Consistent throughout

Was able to generate theoretical

inferences about core components of an optimal system for early warning systems from the review

Used both translational mobilisation theory and normalisation process theory

Weaknesses

Out of the 86 papers only 46 focused on TTT (target-to-treat) implementation and 22 of these were from an adult focused search.

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PICO - since it's intervention

no comparison

outcome -  deterioration

P - Paediatric patients

I - Paediatric early warning system

C - Standard practice / No comparator

O - Deterioration

# data[].attributes.body
Key words: PEWS, deteriorating patient, nurses.
Boolean operators: AND, OR
Databases: Cinahl, cochrane library

# data[].attributes.body
P- Nurses
I- Effectiveness of PEWS helping to identify deteriorating patient
C-
O- Identifying the deteriorating patient

# data[].attributes.body
P- Nurses
E - Effectiveness of PEWS
0 - Identifying the deteriorating patient

Question -
What is the effectiveness of Paediatric Early Warning Systems in helping nurses identify the

deteriorating patient?

# data[].attributes.headline
Effectiveness of paediatric Early Warning Systems in helping nurses identify the deteriorating patient

# data[].attributes.subject
Effectiveness of paediatric Early Warning Systems in helping nurses identify the deteriorating patient