Recommended Citation
Perez K, Panice J, Pujo K, Dawson EC. Modification of a Children’s Hospital Early Warning Score (CHEWS) algorithm. Quality Improvement poster presentation at Empowering Nursing Excellence: Recognizing the Value and Impact of Nurses, Advocate Health Midwest Region Nursing Research & Professional Development Conference 2023; November 15, 2023; virtual.
Presentation Notes
Quality Improvement poster presentation at Empowering Nursing Excellence: Recognizing the Value and Impact of Nurses, Advocate Health Midwest Region Nursing Research & Professional Development Conference 2023; November 15, 2023; virtual.
Abstract
Background
Advocate Children’s Hospital (ACH) adopted the children’s hospital early warning score (CHEWS) from Boston Children’s Hospital. This objective assessment tool categorizes patients by level of risk and tracks changes over time. CHEWS allows for early identification of patient deterioration, proactive management, and prevention of arrest. Each hospital must develop an escalation algorithm based on organizational resources and workflows.
Local problem
The general pediatric inpatient units have been using a CHEWS escalation algorithm with minimal modifications since 2018. Recently, nurses and physicians raised concerns regarding unnecessary CHEWS huddles and rapid responses. These were burdensome, particularly amid times of peak inpatient census.
Method
An interdisciplinary workgroup of nurses and physicians met to review rapid response team (RRT) data and discuss options for adjustments to the CHEWS escalation algorithm. When considering potential changes, objective clinical data and patient safety were prioritized. The team wanted to promote a culture of nurse empowerment, giving the bedside nurse the ability to use clinical judgment, and escalate patient concerns. Various options for changes were explored, and surveys were sent to nurses and physicians for feedback.
Results/Conclusions
Two categories of the CHEWS algorithm were modified. For scores of four, the previous algorithm required a bedside huddle. With the revisions, the nurse considers whether a bedside huddle is needed. For scores of five or greater, former action was to call a RRT. The modified version allows for RRT versus bedside huddle. Nursing documentation in the electronic health record was updated to reflect these changes. Voice recorded education was disseminated to all impacted teammates, and the changes were positively received.
Implications for practice:
CHEWS is one tool to support safe clinical practice. The algorithm changes allow for appropriate actions based on clinical judgment and patient clinical status. RRT data and safety events will be monitored to identify adverse outcomes or late rescue situations.
Document Type
Poster
Publication Date
11-15-2023
Modification of a Children’s Hospital Early Warning Score (CHEWS) algorithm
Background
Advocate Children’s Hospital (ACH) adopted the children’s hospital early warning score (CHEWS) from Boston Children’s Hospital. This objective assessment tool categorizes patients by level of risk and tracks changes over time. CHEWS allows for early identification of patient deterioration, proactive management, and prevention of arrest. Each hospital must develop an escalation algorithm based on organizational resources and workflows.
Local problem
The general pediatric inpatient units have been using a CHEWS escalation algorithm with minimal modifications since 2018. Recently, nurses and physicians raised concerns regarding unnecessary CHEWS huddles and rapid responses. These were burdensome, particularly amid times of peak inpatient census.
Method
An interdisciplinary workgroup of nurses and physicians met to review rapid response team (RRT) data and discuss options for adjustments to the CHEWS escalation algorithm. When considering potential changes, objective clinical data and patient safety were prioritized. The team wanted to promote a culture of nurse empowerment, giving the bedside nurse the ability to use clinical judgment, and escalate patient concerns. Various options for changes were explored, and surveys were sent to nurses and physicians for feedback.
Results/Conclusions
Two categories of the CHEWS algorithm were modified. For scores of four, the previous algorithm required a bedside huddle. With the revisions, the nurse considers whether a bedside huddle is needed. For scores of five or greater, former action was to call a RRT. The modified version allows for RRT versus bedside huddle. Nursing documentation in the electronic health record was updated to reflect these changes. Voice recorded education was disseminated to all impacted teammates, and the changes were positively received.
Implications for practice:
CHEWS is one tool to support safe clinical practice. The algorithm changes allow for appropriate actions based on clinical judgment and patient clinical status. RRT data and safety events will be monitored to identify adverse outcomes or late rescue situations.
Affiliations
Advocate Children’s Hospital