PP077 Topic: AS09–Global Health/Resource Limited Setting/Health Inequalities/Impact of Global Warming/Other: IMPLEMENTATION OF A PAEDIATRIC EARLY WARNING SYSTEM AT BOTSWANA’S NATIONAL REFERRAL HOSPITAL

Abstract

Aims & Objectives: Identification of impending clinical deterioration is challenging in resource-limited settings with high patient-to-nurse ratios and minimal continuous monitoring. Paediatric early warning systems (PEWS) flag children at risk for deterioration and guide escalation of care. At Botswana’s Princess Marina National Referral Hospital, a 2019 audit revealed that paediatric ward nurses only correctly identified 22% of abnormal vitals and only reported 9% of abnormal vitals to a doctor. The ward adopted a PEWS in 2022. This mixed methods implementation study aimed to 1) explore barriers and facilitators to PEWS implementation in our setting, 2) assess acceptability and feasibility of PEWS, and 3) measure effectiveness of PEWS at reducing unplanned clinical deteriorations. Methods: We explored barriers and facilitators through interviews coded using the Consolidated Framework for Implementation Research. We administered the Acceptability and Feasibility of Implementation Measures via staff survey. We defined clinical deterioration events a prior as unplanned ICU transfers, non-palliative mortalities, or initiations of ICU-level interventions on the floor, and tracked these before and after implementation. Results: Identification of abnormal vitals improved from 22% to >85%; doctor notification improved from 9% to >85%. The type of clinical deterioration events changed: initiation of mechanical ventilation (23.2% vs. 12.3%) and vasoactive medications (35.7% vs. 18.5%) decreased, while ICU transfers increased (8.9% vs. 27.7%) (p=0.013). Conclusions: PEWS has improved detection of abnormal vitals among children admitted to our ward and shifted management of deteriorating patients from the ward to the ICU. PEWS has demonstrated potential to improve care for hospitalized children across Botswana. Keywords: sub-Saharan Africa, low-resource setting, early warning systems, escalation of care, implementation science