Developing the Clinical Practice Guideline of Pediatric Early Warning System in Sakon Nakhon Hospital

Abstract

           The aims of this research were to develop the clinical practice guideline of early warning system and evaluate the outcome of its application for pediatric patients in Sakon Nakhon hospital. The participants were 11 nurses and 42 pediatric patients. The instruments were the form for focus group interview, evidence–based review, nursing care plan review and the questionnaire for possibility of using the practice guideline. The three phases of Suecup’s evidence–based practice was applied as a conceptual framework. There were 1) analyzing the problems in clinical practice, knowledge and related contexts 2) investigation of evidence–basedpractice related to clinic problem and clinical guideline drafting and 3) development and trialof clinical practice guideline. Qualitative data were analysed by content analysis and the quantitative data were analysed using mean, percentage and standard deviation.

          The results showed that there were adverse events in the first phase, including unplanned cardiopulmonary resuscitation (CPR), death of patient outside the pediatric intensive care unit (PICU) and readmission at PICU within 72 hours of discharge. In the second phase, the Sakon Nakhon Hospital Pediatric Early Warning Signs (SPEWS) and the doctor report according to the Situation–Background–Assessment–Recommendation (SBAR) were developed. In the third phase, the nurses’ opinion showed that the SPEWS was practical in a high level (x ̅ = 3.86, S.D. = 0.19). The pilot study showed that the nurses could evaluate and monitor the patients earlier. There were no incidents of unplanned CPR and delayed treatment while admitted in PICU such as cardiac arrest and CPR, respiratory failure and endotracheal intubation, shock and incidence of readmitted in PICU within 72 hours.

      Keywords: Early warning signs, Pediatric patient, Critical illness