PEWS charts may not guide staff to sepsis diagnosis, warned HSE

Paediatric early warning system (PEWS) observation charts may not guide clinical staff to a diagnosis of sepsis, according to a recent HSE alert to the system.

A national patient safety alert on 21 June stated that PEWS observation charts and training material required an urgent update to reflect the “recent HSE Sepsis Programme guidance for children and young people”.

The PEWS provides a framework for care and “empowers clinicians to act on behalf of a child with signs of deterioration or about whom they have clinical concerns”. It is designed to make hospital admissions safer for children and help staff to care for deteriorating paediatric patients.

In the recent alert, staff were asked to remove existing printed versions of all paediatric observation charts and replace them with updated versions available at the PEWS webpage.

Local training should be revised to reflect updated national guidance and hospitals should complete three monthly audits to provide assurance that no old versions of the charts are in circulation.

The alert was issued following a review of the materials by a HSE PEWS governance group.

A HSE spokesperson said the International Guidelines for the Management of Septic Shock & Sepsis-Associated Organ Dysfunction in Children (SSCGC) – National Implementation Plan was published in 2021. It includes a clinical decision support tool (sepsis form) which incorporates an early recognition, treatment and referral algorithm for the management of children with septic shock or other sepsis-associated organ dysfunction.

“This alert addresses the requirement to make small amendments to the pre-existing PEWS documentation, to align it with more recent sepsis guidance, namely to prompt initiation of the sepsis form.”

The communication was a “planned update” and was not prompted by patterns in unrecognised or delayed recognition of sepsis in paediatric patients, according to the HSE.

The alert is available here – https://www2.healthservice.hse.ie/organisation/nqpsd/pst/safety-alerts/pews-guidance/