A national paediatric early warning system (PEWS) is set to be introduced this winter across all NHS accident and emergency (A&E) departments in England. Its purpose is to help doctors and nurses identify when a child is deteriorating quickly and get them the care and treatment they need as soon as possible.

Nadia Valentine, a solicitor in JMW’s clinical negligence team, discuses PEWS and how this consistent approach can help ensure children receive the timely treatment they need.

What is PEWS?

The PEWS scoring system, which is already in place across many children’s inpatient wards, will now be extended to A&E.

More than six million children attend A&E each year and this busy department often means clinical teams must make rapid decisions whilst managing significant pressures and competing demands. Noticing a child’s deterioration can be challenging, particularly where symptoms are subtle or their condition is constantly changing.

PEWS works by measuring, recording and assessing key clinical observations including a child’s heart rate, breathing rate, blood pressure, oxygen saturation levels and level of consciousness.

When these observations are brought together they will generate a score that help doctors and nurses recognise early warning signs of serious illness, and identify children whose condition is deteriorating. It is hoped that this monitoring will lead to more consistent communication and decision-making between clinicians, and ensure that children who need more urgent attention receive the appropriate care.

Raising concerns

Under the system, concerns raised by parents, carers, and healthcare professionals can trigger an immediate escalation of care, even when the recorded score is low.

For instance, if the PEWS score shows nothing of concern but parents say the condition of their child is not normal for them, then the nursing staff can escalate for senior review.

The new approach reinforces the importance of partnerships between families and healthcare teams, ensuring that the concerns raised by parents and carers remain heard and can contribute to decisions about their child's care.

The system, developed through collaboration between NHS England, the Royal College of Paediatrics and Child Health (RCPCH) and the Royal College of Nursing (RCN), will also connect emergency medicine, paediatrics and wider children's healthcare teams around a common approach to recognising deterioration.

In such a fast-paced environment like an emergency department, staff need to take notice and react quickly to a child’s worsening condition. Early escalation is extremely important; we have seen multiple cases where there has been a negligent failure to escalate care, resulting in significant harm to the child.

Milestone for children’s healthcare and patient safety

The PEWS approach should help strengthen early identification of deterioration by allowing warning signs to be recognised and communicated sooner, so that decisions can be made more quickly, making a real difference to a child’s treatment, recovery and sometimes their chances of survival.

To ensure that the system is effective, it will be crucial for all nursing staff to have the necessary training and support to identify signs of deterioration and use the system effectively.

Having a consistent approach across all departments in recognising and responding to serious illnesses in children and young people represents an important milestone for children's healthcare and patient safety, providing reassurance to parents and families that where their child is seriously ill, the system will help clinicians spot it in time and get them the care and treatment they desperately need.