Early Warning System for

Pediatrics

REGIE A. BAUTISTA, RN, MN, EdD

Dean, College of Nursing
Systems Plus College Foundation
Angeles City, Philippines
How EWS works
An EWS is a physiologic scoring system typically
used in general medical-surgical units before
patients experience a catastrophic medical event.
This scoring is accompanied by a descriptive
step-by-step guide or algorithm of actions to take
based on the patient’s assessment score.
An EWS can add another layer of early detection
to the rapid response team system, helping staff
recognize high-risk patients before their condition
deteriorates.
Purpose
An Early Warning Score must be used for all
patients within a hospital setting when recording
observations/vital signs, to aide:
Early detection of detrimental changes
Safe, timely, effective management of care in response to a
patient’s deteriorating condition.
The EWS is required to be communicated
between staff when transferring patients between
areas and with requests for clinical assistance.
For a Pediatric patient the following observations/symptoms must
be completed on admission to obtain accurate PEWS. Subsequent
observation requirements are determined by the PEWS
management plan and/or the medical team.

Respiratory rate calculated over 1 minute

Respiratory distress score
Pulse oximetry
Heart rate for at least ½ minute
Blood pressure
Conscious level (using the AVPU)
Capillary refill time
Note whilst temperature is not included in the PEWS,
a baseline temperature recording is taken on
admission and four hourly thereafter for an inpatient.
Pediatric patients up to 15 years of age, use the age
appropriate Pediatric EWS (PEWS).
Scoring
The nurse scores each indicator according to a
specific behavior or range of vital signs. Each
physiologic indicator is assigned a score, ranging
from 0 to 3, depending on the assessment
outcome.
A score of 0 is considered normal or acceptable.
Scores ranging from 1 to 3 are considered
abnormal or unacceptable.
Scores for all indicators are added to create the
PEWS (Pediatric Early Warning System) score. The
total PEWS score is assigned a color based on the
sum of these numbers: a total of 0 to 2 is green, 3 is
yellow, 4 is orange, and 5 or higher is red.
Here are the actions mandated by
each color:
A yellow score:

Requires the reassessment of the patient by the

charge nurse on duty.
If the charge nurse confirms that the score is
accurate, he or she determines whether
intervention is required, documents assessment
and intervention in the medical record, and
reassesses the patient within 2 hours.
An orange score:
Requires reassessment by the charge nurse and
notification of the first- or second-year medical
resident. The resident alerts the senior resident
and attending healthcare provider of the change
in the patient’s medical condition, and medical
staff takes appropriate action. The direct care
nurse reassesses the patient within 1 hour.
A red score
Requires notification of the rapid response team
and resident. The resident alerts the senior
resident and attending healthcare provider, who
are all expected to respond to the patient’s
bedside. The rapid response team and primary
care team collaborate on the patient’s plan of
care. The direct care nurse reassesses the patient
within 1 hour.
Improving patient outcomes
A standardized acuity assessment and
communication method to recognize and avoid
patient decline may reduce patient mortality and
length of stay.
Standardization increases reliability and
decreases variation in the delivery of patient care.
Terima Kasih!