75 Paws for Thought - the Introduction of a Paediatric Advanced Warning Score in a District General Hospital

Abstract

Background and aims: Dumfries and Galloway Royal Infirmary is a district general hospital in south west Scotland. The paediatric unit comprises 20 beds and is actively involved in the Scottish Patient Safety Programme.Many episodes of critical deterioration in children are caused by reversible respiratory (61%) and circulatory (29%) factors (Monaghan, 2005). Early recognition of these problems is enhanced by early warning score observation systems, promoting rapid intervention.Methods: PAWS is a validated early warning observation chart for the assessment of sick children (Egdell et al, 2008). The charts were designed to be similar to the hopspital's adult early warning score charts, promoting a smooth implementation process across the hopsital, particularly in the accident and emergency department. Observations are charted and scored according to a colour coded system. High scores identify children at risk of deterioration. These children are promptly reviewed by an appropriate member of the medical team.Results: PAWS is now used for all paediatric admissions and assessments. Ongoing audit gathers data on compliance of completion and accuracy of scores.Conclusion: The charts have been well accepted. We now have a common language to communicate patient information and PAWS has become an essential part of the handover process.PAWS: • facilitates rapid recognition of acutelly ill children • Allows staff to prioritise patients for review, treatment and ongoing assessment. • Empowers inexperienced staff who may be reluctant to ask for senior assistance (Day et al, 2005).