The nursing culture of an inpatient pediatric unit was resistant to activating pediatric rapid response team (PRRT) alerts despite guidelines for activation. Nurses routinely assessed patients and assigned a pediatric early warning score (PEWS); however, the level of illness severity was not interpreted consistently among nurses and a PEWS action algorithm did not exist to guide nurses' minimal actions based on the PEWS score. Guided by 3 adult learning theories (Knowles, Kolb, and Bandura) and 1 evaluation model (Kirkpatrick), this staff education project sought to educate pediatric nurses on a PEWS action algorithm and determine whether this project improved nurses' knowledge, situational awareness, and attitude toward activating PRRT alerts. A convenience sample of 30 pediatric nurses completed a preeducation knowledge survey (EKS), attended an interactive PEWS education class, and completed a postEKS. After participating in the class, correct responses on the EKS increased from 43% to 82% and, using the Wilcoxon-signed rank test, a significant increase was noted in nurses' responses to questions related to self-efficacy, factual knowledge, and application. The overall increase in the nurses' self-efficacy and knowledge about the PEWS might enhance critical-thinking skills, foster identification of patients at risk for clinical deterioration, and empower nurses to follow the PEWS action algorithm including activation of PRRT alerts when indicated. This project has the potential to effect positive social change by supporting nurses' actions designed to improve pediatric patient outcomes.

BACKGROUND: Late identification of deteriorating children undermines timely implementation of life-saving measures to prevent cardiopulmonary arrest (CPA) or death. The Pediatric Early Warning System (PEWS) has been validated for use in pediatric acute care settings for early identification of children at increased risk of physiologic deterioration, yet there is a dearth of evidence of the use of PEWS in primary care. Implementing the PEWS in primary care could guide rural primary care practitioners to early detection and prompt management of deteriorating children. This DNP project evaluated the attitudes and perceptions of rural practitioners towards the implementation of the PEWS scoring tool. METHODS: A cross-sectional descriptive design was conducted using an anonymous online survey via an email listserv. RESULTS: Seventeen practitioners responded to the survey, but only 14 participants met criteria for inclusion – 2 males and 11 females. The sex of one participant was not reported. Participants areas of specialization include 79% specialized in family practice, 79% pediatric specialists 14% and (7%) listed as "Other." Thirty-one percent of participants reported a travel distance of over 60 miles, while 39% reported a travel distance of over 60 miles lasting over 60 minutes via ground from a place of care to a hospital that specializes in the pediatric emergency care, and pediatric care respectively. Although 92% reported they have not heard of the PEWS tool prior to this survey, 54% strongly agree that the PEWS could help prevent cardiopulmonary arrest or death. Similarly, 54% of respondents reported they strongly agree that the PEWS can help identify deteriorating children, while 39% somewhat agree. Over 62% strongly agree that implementing the PEWS is appropriate in primary care, while 31% somewhat agree. Fifty-four percent of participants strongly agree they could use the PEWS tool in their practice. DISCUSSION: Participants have a positive view of the PEWS tool and perceive implementation of the PEWS to be a vital clinical decision support tool that could lead pediatric primary care providers to early detection of deteriorating children before the occurrence of an adverse event. Further study could determine the generalizability of implementing the PEWS in primary care.