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The Health Quality & Safety Commission has developed a national paediatric early warning system (PEWS) to help clinicians identify hospitalised tamariki with the potential to become more unwell, so they can respond quickly. 

The system includes:

  • four standardised paediatric vital signs charts (or electronic equivalent), banded by age, with early warning scores
  • a localised escalation pathway
  • effective clinical governance and leadership
  • clinical and non-technical education and training resources
  • ongoing measurement for improvement
  • an escalation process for clinician, tamariki and whānau concerns.

The paediatric vital signs charts are similar to those in the existing national adult early warning system, which the Commission has introduced to hospitals as part of its patient deterioration programme. They use seven vital sign parameters to calculate a paediatric early warning score. When the score is reached, it triggers a response following the local escalation pathway, so the appropriate actions can be taken to manage the tamariki’s condition.

The Commission and the Paediatric Society of New Zealand | Te Kāhui Mātai Arotamariki o Aotearoa developed four nationally consistent, paediatric vital signs charts (PVSCs) during 2020/21 which were tested at five different sites across the motu. The test sites were supported by the Commission’s national programme team, which is clinician-led and includes a paediatrician and a paediatric nurse specialist.

Following an evaluation by the programme team, the PEWS working group approved the national rollout of PEWS during 2022−23. A full compendium of tools and guidance is available to aid implementation in Aotearoa New Zealand hospitals.

We anticipate that all district hospitals will have implemented PEWS by early 2024.

For more information, please email the Commission’s PEWS team:

Last updated: 2nd November, 2022