bedside pediatric early warning system
TRANSCRIPT
BPEWS
Bedside Pediatric Early Warning
System
1. Age specific record
Select the correct
age specific
documentation
record
Five age groups –
five colours
newborn to less than 3 months
3 months and older but younger than
first b irthday
1 year and younger than 5th birthday
5th birthday and younger 12th
birthday
12th birthday and older
< 3m
3-12m
1-<5yr
5-<12yr
>12yr
2. Time
Ensure to start a
new documentation
record
24 hour format
Start time 0700 or
admission time
Date record
Patient label
3. Display
Orientate
documentation
record
Display to show
16 hours (2 pages
are displayed)
Enhances visual
trending
Clipboard
designed to
facilitate practice
4. Document
Document all 7
critical indicators
Graph on the
upper section,
HR, RR, SBP
••
•
Document
Record on the
lower section
Oxygen Saturation
Oxygen Therapy (Oxygen Unit Oxygen
Mode of Delivery)
Capillary Refill
95%FM
00:30
Heart rate
Graph on the lines
Mark with a dot, X or
actual number
VALUE section if
writing in the value
area top, bottom of
scale, advised to
seek immediate
assistance
172
•
Systolic blood pressure
... Document the
blood pressure
(systolic/diastolic)
….only use the
systolic blood
pressure to
calculate the
Bedside PEWS sub
score for BP
Diastolic blood pressure
Graphed
Important to the clinical picture
Not used to calculate the Bedside PEWS
sub score
Respiratory rate
One minute
observation
Visualize the
chest
Note any apnea
Graph on the
lines
Saturation
Chart the actual number
Chart in the square
88%
Amount of Oxygen
Chart amount of oxygen (L or %)
Chart method of delivery (FM, NP, BB, etc)
Chart even if patient in room air (RA)
60% FM
Respiratory effort
Subjective observation by a trained
health care provider
Respiratory effort
Normal
Normal effort, no apnea, no retraction,
passive expiration
Mild
Mildly increased respiratory effort,
retractions, nasal flaring
Respiratory effort
Moderate
Moderately increase work of breathing,
retraction, nasal flaring, tracheal tug
Severe
Severe respiratory effort, retraction, readily
apparent grunting, nasal flaring, head
bobbing, tracheal tug, accessory muscle use
Capillary Refill Time
Chart the number in seconds
Elevate the limb to just above the level of
the heart
Depress the digit / chest for five seconds
and release.
Count in seconds for the colour to return
to baseline.
4 sec
5. Sub-Score
Determine the sub
score for each of
the 7 critical
indicators
6. Calculate BPEWS score
Calculate the Bedside PEWS score , add
all the 7 critical indicators sub scores
together
min score 0
max score 26
Document the Bedside PEWS score in the
box corresponding to the time.
Scoring questions
Scoring between two colours
If you document a critical indicator which
lands between two colours, you would
score on the darker colour
…To allot the patient the higher
surveillance to ensure reassessment in a
shorter period of time.
Missing Indicator If one indicator is not done: If a frontline health
care provider determines not to assess any single indicator, the previous sub score for the indicator can be used to calculate the Bedside PEWS score at that time.
The previous sub score may only be carried over once and not greater than 4 hour period. If any previous sub score are outside of normal range, it is recommended that the provider assess the patient to achieve a new sub score at the current time.
Other assessments
Lower half of
BPEWS form and
back customized
by each hospital
Temperature
Pain Score
Bromage
Sedation Score
Blank space for
additional nursing
care
Vent Settings
Doctor Review
Initials
Pain Score
Indicate pain score used in dash box beside
pain score
Use age appropriate pain score for age
group
Review pain scores used by hospital
FLACC
Numbers
Faces
Bromage Sedation Score
Modified sedation score for children
Bromage Score
0 = awake
1 = occasionally drowsy, easy to arouse
2 = frequently drowsy, easy to arouse
3 = somnolent, difficult to arouse
S = asleep, easy to arouse, normal
sleep
Doctor review
Completed by the bedside health care
provider
Tick box
Check if any member of the primary team
or medical team has reviewed the patient
at the bedside
Please document in nursing note
7. Score matched care
recommendations (SMCR)
BPEWS
score
0 - 2
Response Initial Subsequent
0 - 2 Vital Sign
Documentation
4 hours 4 hourly
Charge Nurse
Review
Routine Routine
Review by
Primary Team
Routine Routine
Senior Medical
Review
Routine Routine
Additional
Similar Patients
2 or more 2 or more
Vital sign documentation
Recommended next vital sign
documentation on the Bedside PEWS
record
Nurse can do more frequent observation
of patient
Charge nurse review
Charge nurse is a senior nurse on the
inpatient ward who reviews the patient at
the bedside
It does not require the charge nurse to do
a physical assessment, but rather to have
a second set of eyes on the patient
Physician review
Review by primary team = any member of
the admitting service
Senior Medical Review = includes
attending physician, fellow and senior
resident. Fellow and senior must review
with the attending by phone if not in house
Monitoring
Recommended additional monitoring at the bedside if the patient has an increasing Bedside PEWS score
Oxygen saturation
ECG monitoring
Close observation
ICU Consult / RAP Team
Patient Ratio Recommended nurse to patient ratio
Nurse : patient ratio
Additional similar patients to the current patient BPEWS score.
2 or more similar patients with a similar score of 0–2 .
2 or less similar patients with a similar score of 6. Can have other patients with lower scores.
Initial vs. Subsequent
Initial recommendation
…applied to times when the child has their
first score and/or the next score has
progressed or recovered into a new risk
range
Subsequent recommendation
…applied when a child has remained static
at a certain risk range on repeated
assessment
Care recommendation
These recommendations are to be applied
in addition to clinical judgment of the
frontline health care professional providing
patient care. They are not intended to
replace clinical judgment, but rather
augment it.
“matching care with need”
Let’s Review
Bedside PEWS
1. Assess: Patient & 7 critical indicators
2. Document: Bedside PEWS record
3. Use colour to determine sub-scores
4. Calculate the Bedside PEWS score
5. Plan: identification, management plan,
timely referral
Resources for Nursing Staff Education desktop slides
Frequently asked questions
Technical manual
Clipboard
Documentation Record Poster
Age Specific Poster
Information Sheet
Bedside PEWS Team
Contacts
Stollery
Dr. Jon Duff
Dr. Dawn Hartfied
Denise Capito ex 1673
Jackie Ruszkowski ex 3838
SickKids
Dr. Chris Parshuram- [email protected]
Kristen - [email protected]
Karen – [email protected]
Thank you