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Implementing a watcher program to improve timeliness of recognition of deterioration in hospitalized children

Evans S, Green A, Roberson A, et al. Implementing a watcher program to improve timeliness of recognition of deterioration in hospitalized children. J Pediatr Nurs. 2021;61:151-6.

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April 7, 2022

A lack of situational awareness can lead to delayed recognition of patient deterioration. To address this problem, the Arkansas Children’s Hospital developed an intervention to increase situational awareness and recognition of, and response to, clinical deterioration and resulting emergency transfers to the intensive care unit (ICU) for pediatric patients.

The intervention consisted of four elements:

  1. Objective (e.g., pediatric early warning score [PEWS]) and subjective criteria (“gut feeling” or family/staff concerns) were used to identified patients who may be at risk of possible deterioration (‘watcher criteria’).
  2. Standardized response to watcher patients, including licensed independent practitioner (LIP) assessment, collaborative communication between the care team, and development of a tailored plan including interventions, expected outcomes, time-frames for meeting those outcomes, and an escalation plan.
  3. Electronic health record (EHR) documentation of patient watcher status, which can be viewed across all areas and departments and available to all staff who may be assuming care responsibilities for the patient.
  4. Centralized watcher huddles providing twice-daily reports on watcher patients, including watcher criteria, details of the tailored plan, and any barriers or concerns. These huddles are led by the house supervisor and including nursing representatives, on-call hospitalist, respiratory therapist, and medical emergency team (MET) nurse.

This intervention was piloted on the Infant-Toddler unit and was expanded across all other medical-surgical units, as well as hematology-oncology and intermediate care unit (IMU) areas. After implementation, the number and rate of emergency transfers to the ICU decreased. Nurses reported that the intervention empowered them to proactively respond to patient deterioration and reduced uncertainty around next steps. Other clinical team members reported that the watcher huddles increased accountability and situational awareness.

This intervention leverages proven safety practices (i.e., triggers, huddles) and has broad applicability for various hospitals and types of complex patient care.

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Evans S, Green A, Roberson A, et al. Implementing a watcher program to improve timeliness of recognition of deterioration in hospitalized children. J Pediatr Nurs. 2021;61:151-6.