Table 8.
Fidelity of adaptation made
| Domain | Sub-domain | Example Quote |
|---|---|---|
| Fidelity Consistent Adaptation | Increase in frequency of PEWS | “Turns are taken every shift in green, every 4 h in yellow, and every hour in red.” (Clinical Staff, Ecuador) |
| "Changes in the PEWS frequency (green—once per shift, maximum every 8 h, yellow—every 3 h, red—every 1 h)” (PEWS Leader, Spain) | ||
| Integration into Medical System/ Records | "It was integrated into the computer system so that it reminds the staff of its completion." (Clinical Staff, Colombia) | |
| "PEWS is being implemented in the electronic medical record since the Pediatric Hemato-Oncology ward no longer works with paper." (PEWS Leader, Spain) | ||
| Constructive Changes to PEWS Algorithm | “Also, certain information about the names of the rooms to which the deteriorating patient is transferred and the necessary data to ensure staff comprehension and facilitate workflow has been added to the algorithm” (PEWS Leader, Mexico) | |
| “The algorithm has been updated to involve on-call doctors and registered nurses who act as supervisors during the evenings and nights, addressing issues and responding to yellow and red calls in the ward where PEWS is implemented” (PEWS Leader, Honduras) | ||
| Fidelity Inconsistent Adaptation | COVID pandemic | “During the pandemic, PEWS was only performed at each shift change, meaning twice a day” (Clinical staff, Argentina) |
| “Evaluation of PEWS is conducted during each shift of work. Previously, there were 3 shifts in 24 h. Now, there are 2 shifts of 12 h each due to staff shortages and the pandemic” (Clinical Staff, Peru) | ||
| Lack of Participation in PEWS use | “It was challenging to implement, but it was achieved. However, there are now doctors who do not consider the nurse's assessment when using the PEWS scale” (Clinical staff, Peru) | |
| “Bad because the medical staff does not participate” (Clinical staff, El Salvador) | ||
| Changes to PEWS Scoring Tool | “The score at which we start rating a patient as yellow and red was reduced” (Clinical staff, Colombia) | |
| “It has been adapted as blood pressure was included, as it was an early symptom in the patient on several occasions” (Clinical staff, Colombia) |