September 2021 Update

Clinical Simulation and Training Advisory Network (CSTAN) Grant
To aid with preparation for state-wide implementation of the ESCALATION system we have been awarded a CSTAN grant to assess if the ESCALATION System education and training program developed for Perth Children’s Hospital adequately prepares health professionals with differing and varied paediatric experience and knowledge. The pilot study is called’ ‘ACTION: Optimising educAtion for the ESCALATION SysTem through clInical simulatiON
The objectives of the study are to:

• Develop an ESCALATION System education and training program that has been validated by consensus with an expert panel
• Use clinical simulation to assess how the education and training program prepares nurses and doctors to use the ESCALATION System
• Evaluate, refine and adapt the ESCALATION System education and training program
• Assess how the pilot study could inform a future research project

We will invite 20 participants (16 nurses and 4 doctors) to volunteer to complete the ESCALATION System education and training program and participate in clinical simulation where they will use the ESCALATION System in up to four clinical scenarios. The results from this pilot study will inform the state-wide education and training program for the ESCALATION System which will assist nurses and doctors to identify and care for children who are becoming more unwell in hospital.    ​

State-wide Roll Out
Implementation of the ESCALATION System state-wide is underway being coordinated through Patient Safety and Clinical Quality, Clinical Excellence Division, WA Department of Health. Progress to date includes:

• Appointed Paediatric Nurse Specialists Janine Lemke & Pania Falconer to support sites for their implementation  
• Commenced development of a centralised online education platform
• Finalising escalation pathways
• Planning implementation schedule

​July 2021 Update

V3.0 ESCALATION System Evaluation
Evaluation of the implementation of v3.0 at Perth Children’s Hospital was completed and included obtaining feedback via focus groups and an audit of documentation and use of the ESCALATION System.

Nurse focus groups
 When providing Feedback on v3.0 ESCALATION System nurses reported they liked:
·         the pain assessment, blood sugar level, the blood pressure area, which was wider and clearer
·         continuity of the patient journey from ED to the ward
·         being able to write the numbers, with the graphical trends 
 
In relation to the family concern variable nurses’ feedback was very positive:

​​The clinician concern variable was also highly valued by nurses:

Feedback on education and training: Nurses reported that they felt prepared for the roll out of the new system and were satisfied overall with the communication, education and training, and level of awareness of the project. Nurses reported that they:

• preferred face to face education and training - opportunity to ask for clarification, gain practical hands on experience and discuss issues relevant for their clinical areas
• found the sessions informative and interactive

 
 
Documentation audit: 205 charts audited and 82 families interviewed across 12 clinical areas 4 weeks following implementation. The audits examined chart use, escalation of care and the use of the family concern variable.
 
Escalation of care:

• 54% charts met criteria for escalation of care
• 90% were for escalation to a senior nurse to review the patient

 
Family involvement:

• 90% parents reported nurses asked them how they felt their child was doing
• 85% felt they were included in their child’s assessment

​

April 2021 Update

The new Escalation system including the Paediatric Acute Recognition and Response Observation Tool (PARROT) was implemented across Perth Children's Hospital on the 28th April. Leading up to the roll out face to face education was provided to hundreds of staff by the ESCALATION project team in preparation for changing over to the new system. Dedicated staff development nurses have been providing support during the implementation process. Online learning resources have also been developed to support staff with the new system during its implementation and as a permanent educational resource. Evaluation of the implementation will begin from mid May. 

February 2021 Update

The ESCALATION system is scheduled for implementation at Perth Children’s Hospital in April. Education is underway with nurses and doctors attending face to face education and online educational packages are also available. The staged roll will be supported by dedicated Staff Development Nurses who will support staff in clinical areas in the transition to using the new system. The ESCALATION system was also presented this month at a Grand Round focusing on sepsis (see pictures). Based on the results of earlier trials the system has been refined and key features include:

• Composite scoring system with 10 weighted variables; assessment of respiratory distress, respiratory rate, oxygen saturations, oxygen therapy, heart rate, central capillary refill time, blood pressure, level of consciousness (or level of sedation), pain score, and clinician/family concern
• 5 age-specific charts: <3 months, 3-12 months,1-4 years, 5-11years, 12 years +
• Respiratory distress assessment and oxygen delivery succinct and objective
• Standardised, clear escalation pathway appropriate for different contexts
• Standardised, clear sepsis pathway to facilitate sepsis recognition and early senior medical review for suspected sepsis
• iSoBAR NOW timely escalation of care communication
• Posters and flyers to promote family involvement