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Schleisman AS, Potthoff M, Schjodt K. 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. J Pediatr Nurs 2022; 63:90-95. [PMID: 34702596 DOI: 10.1016/j.pedn.2021.09.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 08/02/2021] [Accepted: 09/22/2021] [Indexed: 10/20/2022]
Abstract
Pediatric early warning scores (EWS) have been utilized to assist the identification of children at risk for clinically decompensating, experiencing a cardiac or respiratory arrest, or requiring a transfer to a higher level of care. Although their use is widespread, little consistency exists between tools and research evaluating the effectiveness of these tools is lacking. This quasi-experimental project evaluated twenty-five medical-surgical staff nurses' use and perceptions as well as the inter-rater reliability of a newly modified pediatric EWS tool at a free standing, academic Midwestern pediatric hospital. The tool was modified utilizing existing literature and an interdisciplinary team's expertise. Five fictionalized patients, presented in case studies, were developed and nurses were asked to score these patients using the newly modified tool with rationale. Inter-rater reliability was assessed utilizing Fleiss' Kappa and qualitative questionnaire data was analyzed for emerging themes. Overall, Fleiss' Kappa showed that there was moderate agreement between the nurses' judgments and scoring, with scores primarily differing due to the difficulty level 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. This project's findings highlight nurses' concerns that an objective tool may not accurately describe a subjective assessment. The results of this project indicated that use of this tool, with some modifications to address nursing concerns, may help to identify clinically decompensating pediatric patients being treated on medical-surgical units.
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Affiliation(s)
- Adrienne S Schleisman
- Creighton University, Children's Hospital & Medical Center, Omaha, NE 68124, United States of America.
| | - Meghan Potthoff
- Creighton University, 2500 California Plaza, Omaha, NE 68178, United States of America.
| | - Katharine Schjodt
- Children's Hospital & Medical Center, 8200 Dodge Street, Omaha, NE 68114, United States of America.
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Dandoy CE, Kelley T, Gaur AH, Nagarajan R, Demmel K, Alonso PB, Guinipero T, Savelli S, Hakim H, Owings A, Myers K, Aquino V, Oldridge C, Rae ML, Schjodt K, Kilcrease T, Scurlock M, Marshburn AM, Hill M, Langevin M, Lee J, Cooksey R, Mian A, Eckles S, Ferrell J, El-Bietar J, Nelson A, Turpin B, Huang FS, Lawlor J, Esporas M, Lane A, Hord J, Billett AL. Outcomes after bloodstream infection in hospitalized pediatric hematology/oncology and stem cell transplant patients. Pediatr Blood Cancer 2019; 66:e27978. [PMID: 31486593 DOI: 10.1002/pbc.27978] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 08/06/2019] [Accepted: 08/08/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Pediatric hematology/oncology (PHO) patients receiving therapy or undergoing hematopoietic stem cell transplantation (HSCT) often require a central line and are at risk for bloodstream infections (BSI). There are limited data describing outcomes of BSI in PHO and HSCT patients. METHODS This is a multicenter (n = 17) retrospective analysis of outcomes of patients who developed a BSI. Centers involved participated in a quality improvement collaborative referred to as the Childhood Cancer and Blood Disorder Network within the Children's Hospital Association. The main outcome measures were all-cause mortality at 3, 10, and 30 days after positive culture date; transfer to the intensive care unit (ICU) within 48 hours of positive culture; and central line removal within seven days of the positive blood culture. RESULTS Nine hundred fifty-seven BSI were included in the analysis. Three hundred fifty-four BSI (37%) were associated with at least one adverse outcome. All-cause mortality was 1% (n = 9), 3% (n = 26), and 6% (n = 57) at 3, 10, and 30 days after BSI, respectively. In the 165 BSI (17%) associated with admission to the ICU, the median ICU stay was four days (IQR 2-10). Twenty-one percent of all infections (n = 203) were associated with central line removal within seven days of positive blood culture. CONCLUSIONS BSI in PHO and HSCT patients are associated with adverse outcomes. These data will assist in defining the impact of BSI in this population and demonstrate the need for quality improvement and research efforts to decrease them.
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Affiliation(s)
- Christopher E Dandoy
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Tammy Kelley
- Children's Hospital of Atlanta, Atlanta, Georgia
| | - Aditya H Gaur
- St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Rajaram Nagarajan
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Kathy Demmel
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Priscila Badia Alonso
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,University of Cincinnati College of Medicine, Cincinnati, Ohio
| | | | | | - Hana Hakim
- St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Angie Owings
- St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Kasiani Myers
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,University of Cincinnati College of Medicine, Cincinnati, Ohio
| | | | | | - Mary Lynn Rae
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | | | | | | | | | | | | | | | | | - Amir Mian
- Arkansas Children's Hospital, Little Rock, Arkansas
| | | | - Justin Ferrell
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Javier El-Bietar
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Adam Nelson
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Brian Turpin
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,University of Cincinnati College of Medicine, Cincinnati, Ohio
| | | | - John Lawlor
- Children's Hospital Association, Washington, District of Columbia
| | - Megan Esporas
- Children's Hospital Association, Washington, District of Columbia
| | - Adam Lane
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,University of Cincinnati College of Medicine, Cincinnati, Ohio
| | | | - Amy L Billett
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts
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