Early detection of clinical deterioration in a pediatric intermediate care unit: a best practice implementation project.

Background: The Pediatric Intermediate Care Unit (Ped-IMC) provides specialized monitoring and care for children at high risk of clinical deterioration. The Pediatric Early Warning Score (PEWS) assesses key factors, such as vital signs and concerns from parents and nursing staff. The score helps to predict clinical deterioration, trigger a rapid interprofessional response, reduce morbidity and mortality, and enhance staff safety.

Objective: This project aimed to promote the prompt identification of clinical deterioration and boost interprofessional response in a Ped-IMC through the implementation of best practices.

Methods: This project used the JBI Evidence Implementation Framework. A baseline audit was conducted to measure current practices against best practices. A follow-up audit was conducted 6 months after implementation to measure change. The audits investigated cardiopulmonary events and unplanned transfers to the pediatric intensive care unit (PICU). A staff survey measured sense of safety, and the Assessment of Interprofessional Team Collaboration Scale (AITCS) was used to measure job satisfaction and interprofessional collaboration.

Results: After implementation, no cardiopulmonary events occurred (compared to one before implementation), and unplanned PICU transfers decreased from 17 (5%) to 14 (4%). Half of the medical and nursing staff (n = 30) completed the survey: interprofessional collaboration scores were stable, and job satisfaction increased from 88% to 97%. Health care providers reported feeling more listened to, with scores improving from 84% to 90%, while their sense of safety remained stable. Compliance with audit criteria increased from 0% to 100% for criteria 1 to 4, and from 0% to 24% for criterion 5.

Conclusion: Implementing PEWS was feasible and effective in enhancing patient safety. While results showed promising improvements in safety culture, reduced adverse events, and increased staff satisfaction, continued monitoring and long-term evaluations are necessary to ensure that PEWS remains a reliable tool in clinical practice.

Spanish abstract: http://links.lww.com/IJEBH/A423.