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New paediatric early warning system considers parental concerns

A new standardised early warning system for nurses scores children’s risk of deterioration and emphasises the need to act on parental concerns
A nurse monitors a child’s pulse and blood pressure as they lie in a hospital bed

A new standardised early warning system for nurses scores children’s risk of deterioration and emphasises the need to act on parental concerns

A nurse monitors a child’s pulse and blood pressure as they lie in a hospital bed
Picture: iStock

A new national warning system for nurses to quickly identify signs of deterioration in children and act on parental concerns is to be rolled out by the NHS in England.

Paediatric early warning score alerts staff to deterioration

The National Paediatric Early Warning System (PEWS) will allow staff to track possible decline in a child’s condition, collating measurements of blood pressure, heart rate, oxygen levels and levels of consciousness, with scores representing the level of concern.

While many hospitals already have similar systems in place, the change will provide a single, national standardised process for the first time.

Developed across 15 pilot sites over the past three years, the standardised system for England will mean a child’s care will immediately be escalated if a parent or carer raises a concern that a child is getting ill or sicker than the score shows, regardless of other clinical observations.

NHS England national medical director Stephen Powis said the system has been ‘years in the making’ and will allow ‘dedicated clinicians to observe, track and identify deterioration in children’s conditions to get them the help they need faster and more easily’.

‘We know that no one can spot the signs of a child getting sicker better than their parents, which is why we have ensured that the concerns of families and carers are right at the heart of this new system,’ Sir Stephen said.

Programme will implement future guidance from Martha’s rule

Working in partnership with the RCN and the Royal College of Paediatrics and Child Health, NHS England will be issuing a leaflet and video for parents, letting them know how to communicate concerns to healthcare staff.

As the programme develops, NHS England says it will implement any future guidance from Martha’s rule within the early warning system.

Martha’s rule will provide a formal process for families and loved ones to get a second opinion regarding a patient’s care. It was named after 13-year-old Martha Mills who died from sepsis after doctors failed to admit her to intensive care.

Unlike the early warning system for adults, this system has four separate charts, each covering a different age range, including 0-11 months, 1-4 years, 5-12 years, and those aged 13 and over.

System will create consistency between trusts

Alder Hey Children’s Hospital chief nursing officer Nathan Askew told Nursing Standard: ‘I welcome the standardised system across the NHS. It will ensure that when staff move between organisations they do not need to learn a new system and this will have a positive impact on alerting earlier to deterioration.

‘Ensuring that when families raise concerns it results in a review is a welcome development to support Martha’s rule.’


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