Article Text

Download PDFPDF

17 Electronic recording of patient observations with safety functionality in the electronic health record (EHR) for the children’s hospital at in Leeds
  1. Michelle Sykes
  1. Leeds Teaching Hospitals Trust, Project Support Officer, Leeds Teaching Hospitals Trust


Objective Electronic observations incorporating ePAWS (Paediatric Advanced Warning Score) was developed as a bespoke functionality within the EHR for implementation across the Children’s Hospital. ePAWS supports the identification of patients at risk of deterioration using a graded response strategy. To promote effective working, the functionality enables observations to be recorded via mobile device or ward computers and has enhanced safety features to support early identification of the deteriorating child. This work followed the successful development and implementation of eObservations incorporating NEWS2 for adult patients with a recognised improvement in the detection of deteriorating adults.

Methods ePAWS was developed from the existing paper based graded strategy. Logic within the functionality calculated the score and presents the relevant strategy advice to the user on observation submission removing the risk of calculation errors and ensuring appropriate actions are taken. Additional safety features including wristband scanning to support patient identification, requirement for a Registered Nurse countersignature for higher risk scores recorded by a clinical support worker, tasks generated for observation due time and for an intervention to be recorded for higher risk scores. To promote visibility, the ePAWS scores and related strategy colour present on the desktop, mobile and electronic white board. There is also the ability to set bespoke parameters for children with different physiological norms. The functionality displays the results in chart and table views with the ability to tailor this to view different trends.

Recognising the importance of the change in practice required for using the new functionality, an enhanced training and support plan was implemented utilising mandatory e-learning supported by a dedicated training team to provide group, one to one and go-live floor walking.

Results User engagement in the move to digital recording of electronic observations and ePAWS was seen across the Children’s Hospital. Linking ePAWS to the electronic ward view was recognised to promote visibility of deteriorating patients and supporting staff to ensure observations are recorded and actioned in accordance with the strategy, promoting patient safety. Clinicians acknowledged the benefit of observations being recorded on a central digital system enabling all health professionals involved in the patients care to review the observations from anywhere in LTHT and externally. Clinician feedback recognised that a chart view which can be tailored to enable easy identification of trends e.g. looking at a patient’s Blood Pressure over a period of time is valuable.

Supporting implementation with mandatory elearning to be completed prior to go-live and a dedicated support and training team ensured the functionality was quickly, effectively and safely embedded in practice. Staff highlighted the benefits of no missing paper documents, clear awareness of the actions to take and the additional patient safety from Registered Nurse countersigning for patients with higher scores.

Conclusion The implementation of electronic observations and ePAWS has been highly successful, with improvement in the escalation of care for deteriorating patients. The enhanced visibility and additional safety features within the system promote patient safety through clear, standardised strategy adherence.

The utilisation of e-learning and on the ward training and support during go-live was recognised to have supported the safe, timely transition to digital working. The e-learning is now part of the induction programme for all new trust clinical staff.

It is clear that functionality requires user training and support for it to achieve its potential for patient care and safety.

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.