In the paediatric and adolescent ward of the Central Ostrobothnia wellbeing services county, a new operating model was adopted in which the PEWS score is routinely measured for all paediatric patients. This ensures early detection of changes in the patient’s condition.
At the same time, the Medanets app automates the score calculation and documentation as part of everyday nursing routines. The new operating model makes patient monitoring more systematic than before.
Change initiated in response to paediatricians’ needs
The development of the PEWS process was started in response to the wishes of paediatricians. In the previous operating model, PEWS monitoring was started on a doctor’s order, with measurements taken once per shift, for example, or once per day. As a result, doctors could receive information about changes in a patient’s condition relatively late and only intermittently.
To remedy the situation, the entire process was reversed. In the new operating model, PEWS is routinely measured for all patients, until a doctor considers that monitoring is no longer necessary. If the patient’s condition declines after the monitoring is discontinued, it will be restarted. This allows changes in the patient’s condition to be detected earlier than before.
Monitoring has improved situational awareness
“According to the feedback from a doctor on the paediatric ward, the effects of the change are particularly evident to paediatricians as improved situational awareness. Measurements are documented via Medanets and the resulting PEWS scores are transferred right away to the electronic health record, where doctors can then view them,” says Petteri Karhukorpi, nurse and medical device specialist.
In practice, this means a better overall view of the condition of the patients on the ward and faster changes to the care of those patients whose condition is noticed to have changed. At the same time, PEWS scoring provides a shared language for discussing a patient’s condition and supports decision-making across different professional groups.
Medanets supports nurses in assessing the situation
Because the new process involves taking more measurements than before, some nurses felt that their workload has increased. On the other hand, the app’s automation helps ensure compliance with the protocol. “PEWS scoring is based on several vital sign parameters, each with different age group-specific threshold values. Remembering all of them is challenging. The Medanets app calculates the score automatically from the measurement data and shows instructions to the nurse based on that score. For novice nurses in particular, this provides important reassurance and support in assessing the patient’s overall situation,” says Karhukorpi.
Training needed to reinforce the new routine
“Overall, the atmosphere around the process reform has been positive, and the change in the operating model was put to practice fairly quickly,” Karhukorpi summarises. “In the initial stage, supervisors played a significant role in supporting the change. Colleagues also reminded one another about missing measurements when necessary.”
According to Karhukorpi, the challenges were related to practical measurement situations. “For example, measuring blood pressure in paediatric patients is not always easy. The blood pressure cuff may make a child tense or frightened, young patients do not always stay still, and nighttime measurements can disrupt sleep. Reliable measurement of the respiratory rate also requires some time and discreet observation.”
Training will be provided to reinforce the routine. The process will also be further fine-tuned.” Training is being planned on how to carry out the measurements as smoothly as possible. In addition, clinicians are considering whether the process could be amended so that, for example, blood pressure need not be measured every single time. If a child’s sleep is repeatedly disrupted by measurements, we may not be improving their overall wellbeing. However, we need clear ground rules as to when a measurement may be omitted and on what basis.”
The operating model is being expanded across the organisation
The positive experiences gained on the paediatric ward are driving an organisation-wide change. A similar operating model is also being introduced for NEWS monitoring on adult specialised medical care wards. The goal is to adopt a model in which the condition of every patient is systematically assessed, and any exceptions are separately evaluated.
The reform is linked to the MET initiative launched within the Central Ostrobothnia wellbeing services county to ensure that a high EWS score leads to action in accordance with the protocol.