Pews&mews

THIS INCULDE PEDIATRIC & MODIFIED EARLY WARNING SIGN

1. PEDIATRIC EARLY WARNING SCORE (PEWS) &MODIFIED EARLY WARNING SIGN ( MEWS) Presented By Pallavi Sharin Topno M.Sc Nursing

2. DEFINITION PEWS is used to recognize of a pediatric patient in the ward &ensure immediate medical attention to prevent further deterioration

3. 1 2 3 SCORE BEHAVIOUR Playing Alert Appropriate At Baseline Sleeping fussy but comfortable Irritable Inconsolable Lethargic Confused Reduced response to pain CARDIOVASCULAR Pink capillary refill 1-2 seconds Pale capillary refill 3 seconds Grey capillary refill 4 seconds tachycardia of 20 above normal rate Grey mottled capillary refill 5 seconds or above tachycardia of 30above normal rate or bradycardia RESPIRATORY Within normal parameters no retractions Greater than 10 above normal parameters use of accessory muscles 30% +fio2 3+litres /min Greater than 20 above normal parameters retractions40%+fio2 6+litres minute tracheostomy & ventilator dependent Below normal parameters with retractions grunting 50% fio2 8+litres

4. TRIGGER GRADING COLOUR SCORE GREEN 0-2 YELLOW 3 ORANGE 4 RED =/>5

5. NOTE: Asthma patients on continuous albuterol nebulizers will automatically be a 3 due in respiratory status please use clinical judgement & make sure patient is meeting the criteria for not just tachycardia when rating their cardiovascular system T he ward nurse shall complete the PEWS scoring within half an hour of commencement of shift change

6. Patient label/sticker Diagnosis:…………………….. Doctor Date of Admission …. ………………..Time of admission ……………......Department………………….. Date Time Behaviour Cardiovascular Respiratory Total Trigger Action taken

7. MODIFIED EARLY WARNING SIGN

8. DATE &TIME pulse BP Systolic Temp SaO2 SaO2 on oxygen RR APVU or New CA Urine output (ml/ hr over 2 hrs.) MEWS scoring Nurse sign

9. PLEASE INFORM DOCTOR IMMEDIATELY WHEN MEWS IS 3 & ABOVE Name of the doctor informed ………Time of information……..Time of doctor arrival…… Temperature 4 3 2 1 1 2 3 4 <34 34.0-34.5 34.6-35 35.1-35.9 38-38.4 38.5-39.9 40.0-40.4 >40.4 systolic BP(mmHg) <90 90-99 100-110 150-169 170-189 190-200 >200 pulse (bpm) <45 45-49 50-54 55 60 90-99 100-119 120-139 >139 Respiratory rate (breaths/min) <8 8-9 10-11 21-25 26-30 31-36 >36 oxygen on saturation on oxygen (%) <88 88-91 92-95 96 Normal range oxygen on saturation on AIR (%) <85 86-89 90-93 94 96 AVPU or new CA Pain response Voice response Confusion or agitation Urine output (ml/ hr over 2 hours ) <10 <20 >250

10. A Alert V Only response to voice P Only responds to pain u unresponsive AVPU C confusion A agitation CA