PAEDIATRICS
Putting the framework ideas
A joint initiative with the Royal College of Paediatrics and Child Health, NHS Improvement has introduced the first whole-system framework for tackling deterioration of health in children.
well as patient safety and improvement methods will provide a foundation for all elements of care to be enhanced. A NHS Improvement Patient Safety
Alert has been being issued across the NHS to raise awareness of the framework along with a range of other resources to support early identification of deterioration. This includes resources developed in 2015 by NHS England for healthcare professionals, as part of the ReACT (Respond to Ailing Children Tool) designed to improve outcomes and reduce the incidence of deterioration in acutely ill infants, children or young people. Commenting on the new framework,
Fiona Smith, professional lead for children and young people’s nursing at the Royal College of Nursing, said: “There are many factors involved in delivering the best outcome for a child – from the patient safety culture of the hospital to the way healthcare teams work together. The new framework brings all these strands together into one cohesive way of working. It also recognises the need for parents to be treated as partners rather than bystanders in care. Parents can often spot small changes that others may miss and they should play a key role in the care of their child.”
OCTOBER 2016 Other moves
In Scotland, Northern Ireland and the Republic of Ireland there have also recently been moves towards the development and spread of a single Paediatric Early Warning System (PEMS) and NHS Improvement says that these programmes should be looked at carefully for share learning opportunities and consideration about what might be possible in England.
A National Institute for Health Research (NIHR) study is also currently ongoing and is believed to be the largest, most comprehensive study of PEW scores and systems to date.
Launched in November 2014, The PEWS Utilisation and Mortality Avoidance (PUMA) study has set out to examine the features of scores and systems as well as other factors which could be implemented to improve the outcomes of harm, morbidity and mortality in children who deteriorate while they are in hospital. Final results are expected in May 2019.
This research came in response to a 2011 study that compared child health outcomes and death rate in the UK with other European countries and which identified that UK measures of child health were among the worst in Europe.2
The aim is to develop an
into action The Great North Children’s Hospital in Newcastle upon Tyne has introduced a new Paediatric Early Warning System which includes the views and opinions of parents and family. Along with a list of questions and observations, such as heart rate, which help identify sick children, the first question relates to family concerns. When any member of staff meets a child they will ask the family if they are worried or concerned. If the answer is yes immediate action is taken. The same question is asked of nursing staff, so either family of nurse concerns can trigger escalation. Alongside researchers at the University of Southampton, and co-designed with children, families and staff, Southampton Children’s Hospital has designed leaflets aimed at parents and young people. It contains useful questions and a list of interventions that should happen to ensure care is as safe as it can be. Information includes how to get help, checking on medications and doses, and knowing which doctor is in charge of care.
Southampton Children’s Hospital has also introduced staff huddles to promote a proactive approach to patient safety and embed it within the staff culture.
understanding of a number of key pieces of information that could standardise monitoring of children in hospital and help to identify deterioration quickly to ensure that there is an urgent response to save the patient from harm and reduce premature death in hospitalised children. This study is being conducted in four UK hospitals who are looking at the key components that need to be included in a track and trigger score and early warning system, to help identify the children who are sicker and prevent them becoming more unwell.
References
1 Hogan H, Healey F, Neale G, et al. Preventable deaths due to problems in care in English acute hospitals: a retrospective case record review study. BMJ Qual Saf 2012;21:737–45.
2 Wolfe I, Cass H, Thompson MJ et al (2011). Improving child health services in the UK: insights from Europe and their implications for the NHS reforms. BMJ: 342, d1277.
3 Pearson GA (ed) (2008). Why children die: a pilot study 2006.
http://www.cemach.org.uk/
4 Gephart SM et al. Failure to Rescue in Neonatal Care J. Perinat Neonat Nurs. (2011) Jul-Sep;25(3):275-82.
5 NHS Atlas of Variation in Healthcare for children and Young People. March (2012). Reducing unwarranted variation to increase value and improve quality.
www.rightcare.nhs.uk
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