Modification of a Children’s Hospital Pediatric Early Warning Score (EWS): An Evaluation of Inter-Rater Reliability, Nurses’ Critical Thinking and Perceptions of the Tool.
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Most hospitalized pediatric patients receive care outside of the intensive care units. However, initial admission to a general medical-surgical floor does not prevent a child from clinically decompensating, experiencing a cardiac or respiratory arrest, or require a transfer to a higher level of care. As such, pediatric EWS have been utilized to assist the identification of children at risk for experiencing an adverse outcome. Although their use is widespread, little consistency exists between tools and extensive research evaluating the effectiveness of these tools is lacking. The purpose of this project was to modify the current pediatric EWS that is currently utilized at a free-standing, midwestern children’s hospital and evaluate the inter-rater reliability of the newly modified tool. Overall, Fleiss’ Kappa showed that there was moderate agreement between the nurses’ judgements and scoring, differing substantially due to the difficulty of each case study. Nurses’ responses to a questionnaire indicated differing levels of comfort identifying and managing children that present with mid-range total scores as opposed to those who scored in the lower or higher ranges. The results of this project indicated that use of this tool, with some modifications may help to identify clinically decompensating pediatric patients being treated on medical-surgical units.
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