25 July 2019

This fall, all Dutch hospitals with a pediatric ward will have the possibility to implement a single signaling system that provides early warnings to caretakers as soon as the vital functions of admitted children are in danger. Those who work in childcare are familiar with this system known as Pediatric Early Warning Score, or PEWS for short. There are currently at least 45 different PEWS in use across the Netherlands. These were designed to fit local needs, use a variety of parameters, and are rarely usable for proper research due to a lack of scientific validation. To the relief of all who are concerned with childcare, this situation may soon come to an end.

Led by the Nederlandse Vereniging voor Kindergeneeskunde (Dutch Association for Pediatrics, NVK), the professions concerned, Stichting Kind & Ziekenhuis (Child & Hospital Foundation), and research institute NIVEL jointly paved the way for Dutch PEWS.

Joris Fuijkschot, chair of the NVK Patient Safety committee and general pediatrician at Radboud university medical center: “The implementation of this ‘Dutch PEWS’ will allow us to further improve the safety of our pediatric wards.”

Tailor-made
The most important part of the system is a uniform core set of measurements. The results thereof allow for mutual comparison, drawing conclusions, and improving the quality of care. This set was developed with the help of more than 300 healthcare professionals and parents of ill children. As such, the approach taken here is unique in the world. A single core set is necessary in order to tackle heterogeneity in the Netherlands. However, Fuijkschot says, space was deliberately left in for local adjustments: “Practices vary a lot, which is why customization is still possible, per hospital or even per department. If there are good reasons to measure certain things that are not in the core set, this remains possible.”
 
What factors are measured?
The PEWS as it is currently in use registers vital functions such as heart rate, breathing, and blood pressure. The improved Dutch PEWS will take additional factors into account during registration, including the context of hospitalization and specific risks. Fuijkschot: “Take for example a child with asthma or Down syndrome. They often do not act by the book when they are ill, which would be cause for heightened alertness. Another factor that can be registered is the gut feeling parents or nurses might have. Scoring all these factors helps the healthcare professional to be extra vigilant around children who run a higher risk of an abnormal course of illness, even when the vital functions are still normal.”
 
Validation
Initiator and coordinator Joris Fuijkschot emphasizes the unique fact that the improved PEWS was developed in situ with the help of many. After implementation of the system, there will be a period of scientific validation.
The fact that Fuijkschot was involved in the development is no surprise. In 2014, he was the first in the Netherlands to implement the Pediatric Risk Evaluation and Stratification System (PRESS) at Radboud university medical center. This system also seriously considered the remarks and gut feelings of parents in its signaling and registration. For example, if the doctor noticed that the parents became more worried, he would check a red flag on his computer. Everyone in the hospital then knew that they should be extra alert around this patient. “This system taught us many things about the importance of the context; specific circumstances that lead to additional care and attention around a given patient. We applied these lessons during the development of Dutch PEWS.”

Field test
Joris Fuijkschot: “We want to know exactly what capabilities the system has, but also what it is lacking. To find out, we want to start with a number of experiments in the field. These will help us to get real information from practical situations.”

Would you like to register to run an experiment? 

If so, please send an email to joris.fuijkschot@radboudumc.nl. When running an experiment, you will have a lead position in the validation of your PEWS. The project activities will also lead to increased attention and involvement among staff.
 
De Volkskrant and EenVandaag previously paid attention to the first 'child alarm' (in Dutch only).

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