Chapter 4

Identifying Deterioration Early

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Chapter 4: Identifying Deterioration Early

At the core of improving outcomes for paediatric

patients is the recognition and response to the
deteriorating child. The earlier this deterioration is
spotted, the better the outcome is likely to be.

This Chapter will focus on how we respond to

deterioration with specific guidance on Paediatric Early
Warning Scores and Systems (PEWS), as well as some
leading examples.

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 Paediatric Early Warning Scores and Systems

• Aim to assist in the identification of deteriorating

children
• Do not replace clinical judgement
• Different versions all with similar specificity and
sensitivity
• Key is to use a standard one for the organisation

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 Ideal PEWS Tool

• Validated
• Easy to use
• Practical
• Generic
• One Document
• Meet’s Hospital’s needs

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 Score or Threshold/Trigger?

• Some tools use a scored system which

requires values of each observation to be
added together to generate a score which
determines the response.

• Others use a system where scores aren’t used

and if one observation fall outside the normal
range, an appropriate response is required

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 Score or Threshold/Trigger?

• Both systems have their strengths and

weaknesses:
System Scored Threshold/Trigger

Example Can provide a needed

Takes all observations into response when only one
strength consideration observation is triggering.

Example Can lead to mathematical Can lead to increase in

errors and potentially number of responses
weakness incorrect response required.

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Patient Patient 3 Patient Patient 1
4 2
PEWS-SBAR Handover
 RECALL

• It is important to assess deterioration in real

time
• The Recall tool developed at Great Ormond
Street Hospital allows for rapid assessment of
why a child deteriorated and whether all
systems in place were sensitive
• Allows review of PEWS

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 Re-Act Talks

The resource pack provides a link to a series of

Re-ACT talks, videos that provide information on
key areas for consideration in decreasing
unexpected deterioration.

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 Watchers

Sometimes a patient’s observations may be

completely normal. At the same time, you may
feel that something is not quite right and that
further observation is needed.

This is a watcher and relies on your clinical

instinct. It can’t be measured by charts, but
should always be trusted.

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