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Empowering Nurses with Early Warning Scores | Overview


The pediatric ward at Kirehe District Hospital in rural Rwanda has between 10 and 30 patients at any given time and just one or two nurses, resulting in overextended staff. One particular barrier to care expressed by nurses was their discomfort in identifying and intervening with children who are sick or at risk for becoming sicker.

Where We Started

Boston Children’s worked with the hospital staff to implement a pediatric early warning (PEW) score to identify declining patients and provide a common language for nurses and doctors to discuss patients’ status. A training program, including classroom instruction and bedside mentoring, focused on the importance and implications of abnormal vital signs. With direct clinical mentorship, the nurses and doctors then applied and integrated their skills through real-time patient assessments and active feedback. Documenting the PEW score became part of the physician rounding process and existing nursing workflow to improve patient care.

Our impact

Demonstrable improvements in both technical skills and feelings of confidence and empowerment were seen following the training and implementation of the PEW score.

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