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Table 6 Contextual factors impacting on paediatric early warning systems during implementation

From: Development, implementation and evaluation of an evidence-based paediatric early warning system improvement programme: the PUMA mixed methods study

 

Site 1

Site 2

Site 3

Site 4

Key organisational-level changes to the paediatric early warning system

·Response to critical incident and CQC inspections led to several trust-mandated changes (see non-PUMA initiatives)

Nothing to report

Study Chief Investigator with senior clinical position at site left post (no longer present as reminder to frontline staff of PUMA/associated initiatives)

· High level of staff turnover

· Changes to PICU and HDU admissions thresholds – increased likelihood of admission/referral

Hospital involved in wider organisational-level restructuring; some impact on initiatives which required governance and institutional approvals.

Key ward-level changes to the paediatric early warning system

· Increase in number of qualified nursing staff

· Loss of some experienced nursing staff

· Introduction of consistent 24/7 band 6/shift coordinator cover

· Additional, more effective mobile computers

· 2 senior nurses training to become ANPs

· New manager joins ward and reduces HDU transfers, through greater focus on needs of individual patient rather than care plan. Many patients who would previously have been admitted to HDU cared for on the ward

· Nursing handover/team organisation changed; nurses allocated to one section of ward, received handover for patients in that section only

· ANPs no longer included within medical team

· Medical team increased from 8 to 10-person rota, increased capacity to cope with sickness/training absence

· Improvements to monitoring equipment; additional Optiflows & saturation monitors, central monitoring station.

Nothing to report

Additional changes during post-implementation period

Nothing to report

· Loss experienced nursing staff

· Increase in number of band 6 nurses

· Increased use of agency staff

Nothing to report

Nothing to report