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England Rollout of Children's Health Warning System

An early warning system is being rolled out across England to assist doctors and nurses in recognising when a child's health is declining and take any necessary steps to escalate their care.

The national paediatric early warning system (PEWS) allows health professionals to score vital signs, including blood pressure, heart rate, and oxygen levels. They can also take account of preexisting health conditions, and record any suspicion of sepsis.

Four observation and escalation charts covering different age groups also include a section for 'clinical intuition', where a doctor or nurse can log a concern that a child they're caring for is 'just not right'.

Immediate Escalation When Parents Flag Concerns

If a parent or carer raises a concern that their child is getting ill or sicker than the score indicates, the child’s care will be immediately escalated regardless of other clinical observations, NHS England said.

PEWS has been developed by NHS England over the past 3 years in partnership with the Royal College of Paediatrics and Child Health (RCPCH) and the Royal College of Nursing (RCN), with pilot schemes running in 15 locations.

While many hospitals already run a similar system, NHS England said the national rollout will provide a single, standardised process for patients, families, and health professionals to ensure that issues with a child's health are detected, and care is escalated quickly.

As the programme develops, any guidance on the right to request a second opinion in hospitals in England under Martha's Rule would be incorporated within the early warning system, NHS leaders said. The rule was named after Martha Mills, a teenager who died at a London hospital in 2021 after failures to identify and properly treat sepsis.

Professor Sir Stephen Powis, NHS national medical director, said: "We know that nobody can spot the signs of a child getting sicker better than their parents, which is why we have ensured that the concerns of families and carers are right at the heart of this new system with immediate escalation in a child's care if they raise concerns, and plans to incorporate the right to a second opinion as the system develops further."

Warning Scheme Could Be Expanded

NHS England said it would be distributing a leaflet and video content for parents containing information on how they can communicate concerns to healthcare staff and encouraging them to escalate if needed.

Dame Ruth May, chief nursing officer for England, said: "With this initial rollout taking place in hospitals, we are working towards extending this to other settings including accident and emergency departments, ambulances, and the community in the future."

Wendy Preston, head of nursing practice at the RCN, said: "We now need to see this warning system implemented successfully across the NHS. For it to be effective, there must be investment in the training and education of staff so they can use the new warning system to act swiftly when a patient's condition deteriorates."

Dr Mike McKean, vice president for policy at the RCPCH, said: "I’d strongly encourage all paediatricians to look at the chart and consider what they need to do to smoothly transition towards integration and embedding the national PEWS into their trusts."

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