Pediatric Early Warning System (PEWS)

Clinical Support Tools


BC PEWS Instructions for Using the Provincial Flowsheet September 2016

Provider Tools

BC PEWS Escalation Aid August 2015

BC PEWS ED Escalation Aid January 2018

BC PEWS Situational Awareness Poster March 2016

BC PEWS Pediatric Vital Signs Lanyard Card

BC PEWS Lanyard Card

Audit Tools

BC PEWS QI Audit Tool September 2019

BC PEWS ED QI Audit Tool for sites with electronic healh records

BC PEWS Inpatient QI Audit Tool for sites with electronic health records

Order Forms

BC PEWS Flowsheet Order Form February 2016

BC PEWS ED Urgent Care Order Form September 2018


BC PEWS Flowsheet August 2016

Background/ Why Is This Important?

Pediatric Early Warning Systems (PEWS) are used internationally to promote early identification and mitigation of deterioration in hospitalized pediatric patients. BC health authority leaders and clinicians have identified the implementation of PEWS as a high priority in hospitals that care for children.

The Child Health BC Steering Committee endorsed a standardized approach to the development, implementation and evaluation of PEWS in BC hospitals (BC PEWS).  
BC PEWS is a five-component system that provides a standardized framework and language to identify potential deterioration in a child, mitigate the risk and escalate care as needed as early as possible. 

Overview video



What Actions Have Already Been Taken?

Through the work of Child Health BC  and partnering with the Regional Health Authorities,  British Columbia is the first jurisdiction in North America to adapt a province-wide standardized early warning system for pediatrics.


PEWS combined image


The initiative includes a number of phases and components:

  • Inpatient unit implementation: to date BC PEWS is in more than 44 hospitals' inpatient units across the province.
  • Evaluation and research: completed for 14 sites and showed that BC PEWS has resulted in improvements in care, clinical documentation and clinician satisfaction. Opportunities for further education were also documented.
  • A research pilot at Richmond Hospital Emergency Department (ED): to assess the potential value of using PEWS in the ED, which showed similar positive results. 
  • Emergency Department (ED) implementation: expansion of the revised ED version of the BC PEWS initiative to include  emergency department settings (BC PEWS ED).

Where Are We Now?

Based on evaluation and research results, Child Health BC is redesigning the PEWS flowsheet and developed a PEWS Refresher Course as an online education resource. 

Implementation of BC PEWS ED is currently underway, supported by Child Health BC's provincial strategies for education, implementation, and quality improvement and evaluation