Table 6.

Why Adaptations were made

	n	%	Sample Quote
Goal (objective) of adaptation made
Easier to Monitor and Evaluate	919	43.9	"In reality, it was adapted to make the measurement [of PEWS] easier" (Clinical staff, Mexico)
Improve Effectiveness	879	42	"Algorithm adaptations were made to enhance effectiveness. Guidelines were added on when to assign points and when not to" (Clinical staff, Brazil)
Better Workflow Integration	830	39.6	"The frequency of vital signs monitoring was adjusted to the routine schedules" (PEWS leader, El Salvador)
Better Comprehension and Easier use	702	33.5	"We have changed technical words to improve comprehension for the nursing personnel" (PEWS leader, Dominican Republic)
Address Cultural Factors*	n.a	n.a	“Adaptation to the language to be more local” (PEWS Leader, Costa Rica)
Reason why adaptation was made
Lack of Team Coordination & Time	348	16.6	"We reduced the frequency due to the lack of personnel and time to carry it out" (Data Manager, Colombia)
Lack of Necessary Material Resources	186	8.9	“The continued monitoring has been something complicated due to the lack of electronic monitors, since we have to check other patients” (Clinical Staff, Mexico)
Lack of Hospital Leadership Support	92	4.4	"We are missing leadership in the oncology nursing area and support by our oncology nurse supervisor" (PEWS Leader, Chile)
Other	151	7.2	n.a
COVID*	n.a	n.a	“According to the availability of personnel, the use of beds during the Covid period, and the resources” (PEWS Leader, Colombia)

Note: This was a choose all that apply questions with multiple responses. The percentages will not add up to 100%

^*Theme identified from qualitative analysis only