Rising PEWS overnight — structured clinical encounter

Station brief (candidate)

You are the paediatric night registrar in a regional hospital without on-site PICU. The nurse asks you to review Maya, aged 3 years 2 months, admitted yesterday with viral wheeze. Her multi-parameter PEWS has risen over three observation sets. Blood pressure was not recorded at the last two checks. Mother says, “She is getting worse.” You have 12 minutes at the bedside (simulated) and 5 minutes for discussion. [1]

Information available on request

• Weight 14 kg; no technology dependence; immunisations up to date. [1]
• Observations trend (qualitative): increasing oxygen need; tachypnoea then a fall in respiratory rate with reduced interactiveness; persistent tachycardia after temperature settles; SpO2 maintained only on higher oxygen; last two BP fields blank. [1]
• PEWS band still below automatic MET colour on the local chart. [1]
• No code-blue criteria yet. [1]

Tasks

1. State a severity and trajectory summary without overclaiming diagnosis. [1]
2. Interpret the PEWS chart limits (incomplete set, concern override). [1] [4]
3. Demonstrate prioritised ABCDE actions and when you call MET/retrieval. [3]
4. Deliver a structured handover. [1]
5. Discuss one system improvement after the event. [3]

Expected performance

Must achieve

• Goes to bedside; does not defer because band is “only yellow.” [1]
• Names incomplete observations as a risk and completes or escalates. [1]
• Treats caregiver concern as an independent trigger (Mills). [9]
• Age-adapted ABCDE; reassesses after interventions. [1]
• Activates senior/MET early; plans retrieval if capability exceeded. [13] [19]
• Structured ISBAR handover including trajectory and missing data. [17]

Should achieve

• Explains falling respiratory rate as possible exhaustion. [7]
• Distinguishes PEWS tool from rapid-response system. [4] [13]
• Quotes EPOCH carefully: no mortality benefit; reduction in significant clinical deterioration events. [3]
• Mentions critical deterioration as a better metric than rare arrest. [12]

Excellent extras

• States BedsidePEWS seven items and 0–26 range without inventing cut-offs. [1] [2]
• Links to personal baseline reasoning for complex children even though this child is previously well. [16]
• Names four RRS limbs in the system-improvement minute. [13]

Examiner prompts if stuck

• “The score is not at MET threshold — what now?” [1]
• “Which observations are missing and why does that matter?” [1]
• “What did EPOCH actually show?” [1]
• “How will you speak to the retrieval consultant?” [1]

Marking domains

| Domain | Weight | Anchors | [1] |