PEWS:
Pediatric Early
Warning Signs,
Rapid Response
Team, Code Blue
Royanne Lichliter BS, RN
And
Jodi Thrasher MS, CFNP, RN
2/4/09
You Could Be A Lifesaver TOO!!
2
Background/History
 The Children’s Hospital participated in a project with
the CHCA (Child Health Corporation of America) to help
reduce the number of code blues that occur. The PICU
teamed up with the Inpatient Medical Unit, 8th floor, for
this collaborative.
 Collaborative goal was to reduce the number of codes
on level 8 by 50% and double the days between codes
in a year.
 Custom goal is to decrease emergent intubations
occurring on level 8 or within 1 hour of arrival to PICU
by 50% in a year.
Data summarized from: Tucker, J &
Vossmeyer, M “ Watchful Eye Improving
Patient Safety by Early Identification of Risk
PowerPoint” . Cincinnati Children’ s.
3
Failure to Rescue
• Failure to rescue is defined as
inability to save patient’s life by
 Not recognizing deterioration
 Failing to take action to reverse
changes
4
Results!!
 Our Code Blue rate went from 0.22/1000 patient days to
our current rate of 0.09/1000 patient days.
 Our number of emergent intubations decreased from
0.66/1000 patient days to 0.26/1000 currently.
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SBAR
Situation, Background, Assessment,
Recommendation
SBAR
• Situation: Identify the situation you are calling
about. Identify patient and self. State the
problem
• Background: Provide pertinent back ground
information about the situation, diagnosis,
medications, VS, lab results, code status
• Assessment: What is the assessment of the
situation?
• Recommendation: What do you want?
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The PEWS Tool
Pediatric Early Warning Signs:
PEWS
0
1
2
3
Behavior
•Playing
•Alert
•Appropriate
•At baseline
•Sleep
•Fussy but
consolable
•Irritable/Inconsolable
•Lethargic
•Confused
•Reduced response
to pain
Cardiovascular
•Pink
•Capillary refill
1-2 seconds
• Pale
• Capillary refill 3
seconds
•Grey
•Capillary refill 4
seconds
•Tachycardia of 20
above normal rate
•Grey
•Mottled
•Capillary refill 5
seconds or above
•Tachycardia of 30
above normal rate
or bradycardia.
Respiratory
•Within normal
parameters
• No retractions
•Greater than 10
above normal
parameters
•Use of accessory
muscles
•30+% FiO2
•3+ Liters/minute
•Greater than 20 above
normal parameters
•Retractions
• 40+% FiO2
• 6+ Liters/minute
•Trach &ventilator
dependent
•Below normal
parameters with
retractions
•Grunting.
•50% FiO2
•8+ Liters/minute
Green=0-2 Score
Yellow=3 Score
Orange=4 score
Score
Red =5 or Greater Score
Please Note: Asthma patients on continuous albuterol nebulizers will automatically be a 3 due to respiratory status, please use
clinical judgment and make sure the patient is meeting the criteria for not just tachycardia when rating their cardiovascular
Page 9
system
Adapted from Cincinnati Children's’ PEWS
Pews Flowchart
Families often know their chil d best. Pl ease remember to listen to
thei r concerns and advocate for them .
P t adm i tted to
inpati ent unit
Pt as ses sed/
reas s es sed by
R N inc ludi ng
PEW S s core
PEWS
Sc ore
0-2
P EWS
Sc ore
T otali ng
3
R eas s es s and
res c ore at next
routi ne
as s es sm ent
Individual
PEWS score
of 3 in any
category
PEW S
Sc ore
4
PEW S
S core
5
N oti fy res ident/
i nt ern and
c harge R N of
c lini cal c hange
N otif y c harge R N,
res ident /intern ,
s uperv is ing
res ident
N oti fy charge R N,
res i dent /intern ,
s uperv is ing
res i dent , nurs ing
s uperv is or and
attendi ng
Plan and
coll aborat e w ith
entire heal th c are
team.
Pl an and
c ol laborate w ith
enti re health c are
team.
Pl an and
c ol laborate w it h
enti re health c are
team.
D ocum ent and
det ermi ne t im e
of next
as ses sm ent
and res c oring
If sti ll
c onc erned
notify attendi ng and
nursi ng s upervi sor and
consi der
R R T ev al
R R T eval
X75555
N oti fy
s uperv is ing
resi dent /
attendi ng
x75555
D oc ument and
reas s es s af ter
interv enti on .
Pl an and
c ol laborate w it h
enti re health c are
team.
Page 10
Code Blue
• What it is
 Activation of an emergency response team, the code team, when patient arrest or rapid decline in a patient
condition
• Who responds
 Code Team members
•
•
•
•
•
•
•
•
PICU fellow
PICU charge
ED charge
Anesthesia
Surgery
Pharmacy
Nursing Supervisor
Resource Nurse
• How to call
 75555
 Operator will ask what your emergency is
 State you have a code blue and location
 Code Blue Team receives a page
 Announced overhead
• When to Call
 Respiratory Arrest
 Severe respiratory distress
 Cardiovascular Arrest
 Impending Cardiovascular Arrest
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Rapid Response Team
Rapid Response Team
• What it is
 This is a process to allow any staff or family member to get immediate
evaluation of a patient
• Who responds
 PICU fellow and charge nurse respond
 Goal response time is 10 minute
• How to call
 75555
 Operator will ask what your emergency is
 State you would like a Rapid Response Team and which room number
 Rapid response team receives a page on pager
• When to call
 Important to escalate concerns through chain of command
 Anybody can call
 Call when you are worried about patients condition and their potential
for decline
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