(54) Consistency in Care, Confidence in Crisis: Improving Patient Safety Through Standardizing Tools & Training

Title: Consistency in Care, Confidence in Crisis: Improving Patient Safety Through Standardizing Tools & Training

Abstract : Recent safety events highlighted challenges in identifying decompensating patients in the inpatient pediatric hematology/oncology population. Variable utilization of existing identification tools contributes to delayed recognition of decompensation related to differences in care team experience, lack of standardized response protocols, and unclear role responsibilities. These issues contributed to missed opportunities for early intervention, resulting in a significant rise in patient safety events within a short amount of time.
The objective of this initiative was to implement a more reliable and validated early warning score tool to aide identification of decompensation, alongside an escalation algorithm focused on timely bedside evaluation. The goal was to educate 85% of hematology/oncology nurses and providers by December 2024.
Methods employed include evaluation and adoption of a scoring system as well as education and implementation that followed. A multidisciplinary workgroup was formed to review and analyze several validated scoring systems and escalation algorithms. The team adopted the Children's Hospital Early Warning Score (CHEWS), a validated tool developed at Boston Children’s. The group developed simulation scenarios focused on recognition of deterioration using the CHEWS scoring tool, interdisciplinary engagement, communication and shared decision making followed by a standardized debrief.
Over one month, eight simulation sessions trained 191 staff members (81 MD/DOs, 18 APPs, and 92 RNs) across inpatient and outpatient settings, covering 99% of hematology/oncology nurses and 95% of providers. Post-education and CHEWS implementation, scoring accuracy reached 90%. Key outcomes included improved standardization in education and response protocols, better clinical decision-making, and enhanced preparedness and critical thinking through simulation training. Lessons learned highlighted the benefits of structured systems for early clinical deterioration recognition, improved collaboration, and the need for ongoing CHEWS monitoring. These efforts led to zero cardiopulmonary resuscitations or intubations from August 2024 to today, significantly improving patient outcomes and safety in pediatric oncology.