468 Making a Difference: Introducing Paediatric Critical Care Outreach Supports Effectiveness of An Early Warning Scoring System Improving Patient Safety

Abstract

Nottingham Children's Hospital has recently developed and introduced an integrated Paediatric Early Warning Scoring tool and Observation Chart. To support this development and to enable the structured escalation plan to be instigated, a PCCOT team was also introduced and trialled for one month. The aim of the trial was to find out what added benefit the PCCOT Nurse contributed to the PEWS system in the recognition and management of evolving critical illness thus enhancing patient safety. Other aims included improvement to the patient treatment pathway, to assess the types/range of skills the PCCOT Nurse needs and the level of activity of the PCCOT Nurse. Utilising a service redesign model the project has moved through the following stages: Problem Identification Identifying issues surrounding ‘failure to rescue’ Proposed initiative PEWS and PCOTT. Development of Tool - PEWS, observation chart and escalation plan. Pilot Stage The trial of PCOTT and new charts took place over 1 month. Results: Total Number of patients 137. Average Number of PCCOT episodes per day 20 Time spent per episode 15 min - 6 hours Average PCCOT episodes per patient 5 Patients admitted to PICU/PHDU had higher PEWS score. Of 15 patients admitted to a higher level of care the transfers were controlled and timely. During the trial there were no cardiac arrests on the wards and only one ‘collapse’ needing ITU admission from a ward where PCOTT had not been involved. Conclusion: Paediatric Critical Care Outreach supports the effectiveness of a PEWS System improving patient safety.