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Early Detection and Treatment for Children: Experiences and outcome of implementation at a pediatric hospital
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.ORCID iD: Hanna222
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Early recognition of severely ill children is necessary to prevent serious adverse events and unexpected death. To promote patient safety the Early Detection and Treatment Program for Children (EDT-C) was developed at a University Children’s Hospital in Sweden. This program consists of validated tools for communication and teamwork combined with the Pediatric Early Warning Score (PEWS) and guidelines for recommended actions. Ward specific guidelines were developed and EDT-C instructors were trained. The aims were to describe healthcare professionals’ experience of caring for acutely, severely ill children (Study I) and to evaluate the implementation of EDT-C (Study II, III, IV). The Promoting Action on Research Implementation in Health Services (PARiHS) framework guided both implementation and the research study.

Before introducing the EDT-C, focus group interviews were performed to explore healthcare professionals’ experience of caring for acutely, severely ill children. A context assessment, using the Alberta Context Tool (ACT) was also conducted. After implementation, a retrospective review of the electronic patient records (EPR) to assess adherence to guidelines were carried out. Instructors’ and healthcare professionals’ experiences from the implementation of EDT-C were gathered through individual interviews. To evaluate the introduction of EDT-C in relation to admission and stay at intensive care a retrospective before-after study using EPR data was performed. Interviews were analyzed using qualitative content analysis and descriptive statistical methods were utilized for quantitative data.

The caring for acutely severely ill children was described as being in a multifaceted area of tension with paradoxical elements where contradictory emotions emerged. According to documentation, children at a very high risk of clinical deterioration according to PEWS were identified. Adherence to actions prescribed in guidelines varied.

 Healthcare professionals and instructors described EDT-C as suitable for clinical practice and that it created a more structured way of working. It was furthermore described that PEWS measurement had become routine practice at the hospital.

EDT-C can lead to increased knowledge about early detection of deterioration, strengthen the healthcare in their profession, optimize treatment and teamwork and thereby has potential to increase patient safety for children treated in hospitals.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2018. , p. 64
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1410
Keywords [en]
PEWS, Pediatric, Clinical deterioration, inter-professionell, teamwork, ACT, PARiHS
National Category
Pediatrics
Research subject
Medical Science
Identifiers
URN: urn:nbn:se:uu:diva-335920ISBN: 978-91-513-0185-3 (print)OAI: oai:DiVA.org:uu-335920DiVA, id: diva2:1164195
Public defence
2018-02-09, Sal IV, Universitetshuset, Biskopsgatan 3, Uppsala, 09:15 (Swedish)
Opponent
Supervisors
Available from: 2018-01-15 Created: 2017-12-11 Last updated: 2018-03-07
List of papers
1. Caring for the Acutely, Severely Ill Child-A Multifaceted Situation with Paradoxical Elements: Swedish Healthcare Professionals' Experiences
Open this publication in new window or tab >>Caring for the Acutely, Severely Ill Child-A Multifaceted Situation with Paradoxical Elements: Swedish Healthcare Professionals' Experiences
2016 (English)In: Journal of Pediatric Nursing: Nursing Care of Children and Families, ISSN 0882-5963, E-ISSN 1532-8449, Vol. 31, no 5, p. E293-E300Article in journal (Refereed) Published
Abstract [en]

Purpose: The aim of this study was to describe healthcare professionals' experience of caring for acutely, severely ill children in hospital in Sweden.

Design and Methods: Five focus group interviews were conducted with nurses, nurse assistants and physicians comprising a total of 20 participants. Data were analyzed using qualitative content analysis.

Results: An overall theme emerged that describes healthcare professionals' experiences as: "being in a multifaceted area of tension with paradoxical elements". The theme is based on three categories: proficiency of the individuals and the team is the fundamental base; interactions are crucial in an area of tension; and wellbeing of the individual is a balance of contradictory emotions. With maintained focus on the ill child, proficiency is the fundamental base, interactions are crucial, and moreover contradictory emotions are described.

Conclusions: The interplay based on proficiency may influence the assessments and treatments of acutely, severely ill children.

Practice Implications: Recognizing the multifaceted area of tension with paradoxical elements, practical teamwork exercises, a structured approach, and assessment tools could be a possible way to develop interprofessional team collaboration to improve the care of acutely, severely ill children in order to increase patient safety.

Keywords
Content analysis, Interprofessional, Focus groups, Pediatric care, Healthcare professionals, Children
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-306761 (URN)10.1016/j.pedn.2016.05.001 (DOI)000384134300001 ()27237793 (PubMedID)
Available from: 2016-11-10 Created: 2016-11-03 Last updated: 2017-12-20Bibliographically approved
2. Implementation of Pediatric Early Warning Score: Adherence to Guidelines and Influence of Context
Open this publication in new window or tab >>Implementation of Pediatric Early Warning Score: Adherence to Guidelines and Influence of Context
2018 (English)In: Journal of Pediatric Nursing: Nursing Care of Children and Families, ISSN 0882-5963, E-ISSN 1532-8449, Vol. 38, p. 33-39Article in journal (Refereed) Published
Abstract [en]

PURPOSE: To describe data of Pediatric Early Warning Score (PEWS) registrations and to evaluate the implementation of PEWS by examining adherence to clinical guidelines based on measured PEWS, and to relate findings to work context.

DESIGN AND METHODS: PEWS, as a part of a concept called Early Detection and Treatment-Children (EDT-C) was implemented at three wards at a Children's Hospital in Sweden. Data were collected from the Electronic Patient Record (EPR) retrospectively to assess adherence to guidelines. The Alberta Context Tool (ACT) was used to assess work context among healthcare professionals (n=110) before implementation of EDT-C.

RESULTS: The majority of PEWS registrations in EPR were low whereas 10% were moderate to high. Adherences to ward-specific guidelines at admission and for saturation in respiratory distress were high whereas adherence to pain assessment was low. There were significant differences in documented recommended actions between wards. Some differences in leadership and evaluation between wards were identified.

CONCLUSIONS: Evaluation of PEWS implementation indicated frequent use of the tool despite most scores being low. High scores (5-9) occurred 28 times, which may indicate that patients with a high risk of clinical deterioration were identified. Documentation of the consequent recommended actions was however incomplete and there was a large variation in adherence to guidelines. Contextual factors may have an impact on adherence.

PRACTICE IMPLICATIONS: EDT-C can lead to increased knowledge about early detection of deterioration, strengthen nurses as professionals, optimize treatment and teamwork and thereby increase patient safety for children treated in hospitals.

Keywords
Deterioration, Implementation, PARIHS, Pediatric, Pews
National Category
Pediatrics
Research subject
Pediatrics
Identifiers
urn:nbn:se:uu:diva-336550 (URN)10.1016/j.pedn.2017.09.002 (DOI)000423035000019 ()29167078 (PubMedID)
Note

Supplementary data to this article can be found online at https://doi. org/10.1016/j.pedn.2017.09.002

Available from: 2017-12-14 Created: 2017-12-14 Last updated: 2018-02-28Bibliographically approved
3. Increased intensive care admission rate after introduction of Early Detection and Treatment program for Children and the establishment of a pediatric intensive care unit at a tertiary hospital in Sweden
Open this publication in new window or tab >>Increased intensive care admission rate after introduction of Early Detection and Treatment program for Children and the establishment of a pediatric intensive care unit at a tertiary hospital in Sweden
(English)In: Article in journal (Refereed) Submitted
Abstract [en]

Objective: To evaluate the introduction of an Early Detection and Treatment program- Children (EDT-C) including a paediatric early warning score (PEWS) in relation to admission and length of stay at intensive care unit (ICU). Design: Before-after study utilizing data from the Electronic Patient Record (EPR) system, comparing outcomes over a total time period of 60 months between April 2010 and September 2015. Setting: A Swedish tertiary hospital. Patients: A total of 16,283 paediatric patients were included over the study period. Interventions: EDT-C including PEWS Measurements and Main Results: The following variables were extracted from the EPR data: 1) Admissions to paediatric wards 2) Length of stay at paediatric wards 3) Admissions to intensive care units 4) Length of stay at intensive care unit 5) Diagnosis. Intensive care unit admission increased from 5.0% (440/8746) before to 10.2 % (772/7537) after the introduction of the EDT-C (p<0.01). Mean treatment time at ICU did not change (41.0 vs 48.3 hours, p=0.23). Conclusion: The introduction of EDT-C including PEWS, in conjunction with the establishment of a paediatric intensive care unit at the hospital, resulted in an increased intensive care admittance rate among paediatric in-patients.

National Category
Clinical Medicine Pediatrics
Research subject
Pediatrics
Identifiers
urn:nbn:se:uu:diva-336775 (URN)
Available from: 2017-12-17 Created: 2017-12-17 Last updated: 2017-12-20
4. From skepticism to assurance and control: implementation of a patient safety system at a pediatric hospital in Sweden
Open this publication in new window or tab >>From skepticism to assurance and control: implementation of a patient safety system at a pediatric hospital in Sweden
(English)In: Article in journal (Refereed) Submitted
National Category
Pediatrics
Research subject
Pediatrics
Identifiers
urn:nbn:se:uu:diva-336557 (URN)
Available from: 2017-12-14 Created: 2017-12-14 Last updated: 2017-12-20Bibliographically approved

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