My padlet- ebn by https://padlet.com/akillen07/vaq3is8t4czhjaui en-us 2020-10-31 14:12:43 UTC 2020-11-13 12:04:01 UTC hello@padlet.com Effectiveness of paediatric Early Warning Systems in helping nurses identify the deteriorating patient akillen07 https://padlet.com/akillen07/vaq3is8t4czhjaui/wish/878637818  ]]> 2020-10-31 14:15:35 UTC https://padlet.com/akillen07/vaq3is8t4czhjaui/wish/878637818 PE0 akillen07 https://padlet.com/akillen07/vaq3is8t4czhjaui/wish/878639615 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?
]]> 2020-10-31 14:17:44 UTC https://padlet.com/akillen07/vaq3is8t4czhjaui/wish/878639615 Strategy cmccomb06 https://padlet.com/akillen07/vaq3is8t4czhjaui/wish/883044818 Key words: PEWS, deteriorating patient, nurses.
Boolean operators: AND, OR
Databases: Cinahl, cochrane library

]]> 2020-11-02 16:48:41 UTC https://padlet.com/akillen07/vaq3is8t4czhjaui/wish/883044818 PICO bethmckillen https://padlet.com/akillen07/vaq3is8t4czhjaui/wish/884059355 PICO - since it's intervention
no comparison
outcome -  deterioration
P - Paediatric patients
I - Paediatric early warning system
C - Standard practice / No comparator
O - Deterioration
]]> 2020-11-02 20:48:18 UTC https://padlet.com/akillen07/vaq3is8t4czhjaui/wish/884059355 PICO cmccomb06 https://padlet.com/akillen07/vaq3is8t4czhjaui/wish/888072512 P- Nurses
I- Effectiveness of PEWS helping to identify deteriorating patient
C- 
O- Identifying the deteriorating patient]]> 2020-11-03 22:43:55 UTC https://padlet.com/akillen07/vaq3is8t4czhjaui/wish/888072512 Paper 1 - Research bethmckillen https://padlet.com/akillen07/vaq3is8t4czhjaui/wish/919658772 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.
]]> 2020-11-13 10:17:25 UTC https://padlet.com/akillen07/vaq3is8t4czhjaui/wish/919658772 Paper 2 - Research bethmckillen https://padlet.com/akillen07/vaq3is8t4czhjaui/wish/919660678 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.
]]> 2020-11-13 10:18:47 UTC https://padlet.com/akillen07/vaq3is8t4czhjaui/wish/919660678 Paper 3 - Research bethmckillen https://padlet.com/akillen07/vaq3is8t4czhjaui/wish/919661454 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. 
]]> 2020-11-13 10:19:15 UTC https://padlet.com/akillen07/vaq3is8t4czhjaui/wish/919661454 Questions bethmckillen https://padlet.com/akillen07/vaq3is8t4czhjaui/wish/919782986 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

]]> 2020-11-13 11:42:40 UTC https://padlet.com/akillen07/vaq3is8t4czhjaui/wish/919782986