PAEDIATRIC OBSERVATION PRIORITY SCORE
(POPS)
TRAINING PACKAGE FOR EMERGENCY
DEPARTMENT STAFF.
PRACTITIONER
SUPERVISOR
DATE
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Background.
The 6 million children presenting at urgent care settings each year, there are
some very sick children who require early recognition. It is based on this early
detection that good risk stratification is performed. However, a large majority
of parents require only guidance, advice and minimal intervention for their
child’s illness.
The Confidential Enquiry into Maternal and Childhood Health (CEMACH)
indicated that childhood death could be prevented if health professionals were
better at recognising sick children at an early stage. This was also supported
by The National Patient Safety Agency (NPSA), with both reports suggesting
the use of an early warning score system.
The Paediatric Observation Priority Score (POPS) is a physiological and
observational scoring system designed for all members of frontline staff,
enabling them to make swift, reliable and appropriately prioritised clinical
judgements and decisions.
Aim.
To ensure all staff undertaking paediatric observations with the emergency
department are knowledgeable and confident in using the POPS system, thus
allowing for early recognition of serious illness, deterioration and early
intervention. As the POPS system is an aide to assist in decision making, it
can also support the basis for appropriate discharges and suitable redirections to the primary care team.
Outcomes.
For all staff working with children within the emergency department to
recognise, utilise and action the POPS score for all children requiring
observations. All children will require a basic minimum set of observations:
temperature, pulse, O2 saturations, capillary refill time, respiration rate and a
POPS score.
All children should have repeat observations and POPS score prior to
discharge. This may be performed within 45 minutes of discharge.
An evidence based competency training package will be completed and held
by the POPS supervisors.
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Normal paediatric parameters.
These observations are taken and adapted from the Paediatric Resuscitation
Formulae and all considered to be normal (APLS 2010). If for any reason, the
child you are assessing falls outside these ranges contact a member of staff
who will be able to provide advice on the best course of action.
A child’s temperature and blood sugar are within the same ranges of an adult.
Age
Respiratory Rate.
Pulse.
Systolic BP
<1
30-40
110-160
70-90
1-2
25-35
100-150
80-95
2-5
25-30
95-140
80-100
5-12
20-25
80-120
90-110
>12
12-20
60-100
100-120
INCLUSION CRITERA WHEN TO US POPS

Medical Patients.

Head Injuries.

Multiple Traumas.
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Self Assessment
Using the POPS system requires the ability to undertake specific observations
within all age’s groups of children. The skill to undertake such observations is
outlined within The Royal Marsden Hospital Manual of Clinical Nursing
procedures 6th Edition (2004). Further information regarding Paediatric
nursing observations can be accessed within the three minute tool kit
described at www.spottingthesickchild.com
Consider the following elements of practice and record methods of how to
undertake each skill giving examples of differences noted between the age
groups.
POPS
Category
Method of skill/
Age group
considerations
Features if
score 0
Features if
score 1
Features if
score 2
Oxygen
Saturations
Breathing
(work of
breathing)
AVPU
Gut Feeling
Other
Pulse
Respiratory
Rate
Temperature
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A note on Capillary Refill and Blood Pressure
“Poor capillary refill and differential pulse volumes are neither sensitive nor
specific indicators of shock in infants/children, but are useful clinical indicators
when used in conjunction with other signs”, also note that the presence of a
temperature does not affect the sensitivity of a delayed capillary refill in
children with hypovolaemia, but a low ambient temperature will reduce its
specificity. It should not be used solely as an indication of deterioration of
clinical status (APLS 2010). CRT is not part of the POPS system but should
be recorded on the APT form to help aid decision making.
Blood Pressure is also not part of the POPS system but should be taken in
any child who there is concern about their cardiovascular status whether this
be a primary cardiac problem or secondary shock, dehydration or concern
with renal problems.
Actions
The POPS system is not prescriptive and should never overrule clinical
judgement. However the following is guidance.
POPS 0-1
Could this child be seen by Urgent Care?
POPS 1- 3
These children must have a set of discharge
Observations performed.
POPS 3 +
Junior doctors to discuss child with senior prior to
discharge.
POPS 4- 6
This child must have a repeat set of observations
recorded very hour. All observations must be
documented onto an observation chart to map any
trend. Inform senior doctor.
POPS 7+
This child requires a senior review in resus.
The paediatric team should also be contacted.
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P.O.P.S Scoring in Practice - 1
7 year Girl presents with a fever and rash
She is normally fit and well with not past medical history of note
Observations recorded:
She looks a little pale and you are very concerned she looks unwell. There is no
obvious breathing difficulty. She has a rash on her leg. She is alert to questions.
HR: 129
RR: 31
Temp: 38.9
Sa02: 98%
Using the P.O.P.S system, what score would you give this patient?
Describe the actions would you take now.
Date
Practitioner Signature
Clinical Supervisor Signature
P.O.P.S Scoring in Practice - 2
9 year boy who is a known Insulin dependent diabetic
He has been unwell for 1 day with diarrhoea and vomiting
Observations recorded:
He looks very drowsy and only opens his eyes in response to questions. He has no
recession.
HR: 122
RR: 41
Temp: 36.7
Sa02: 96%
Using the P.O.P.S system, what score would you give this patient?
Describe the actions would you take now
Following treatment and prior to discharge from the department to the ward, the
following observations have been completed as part of the discharge process:
Patient appear’s alert and orientated.
HR: 102
RR: 24
Temp : 36.8
Sa02: 98%
Sa02: 98%
Using the P.O.P.S system, what score would you give this patient?
Date
Practitioner Signature
Clinical Supervisor Signature
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P.O.P.S Scoring in Practice - 3
2 year old boy has had a cold for 3 days. Previously fit and well with no medical
problems.
Observations recorded:
He appears well and has no obvious breathing difficulty
HR: 100
RR: 26
Temp: 36.9
Sa02: 99%
Using the P.O.P.S system, what score would you give this patient?
Describe the actions would you take now.
Date
Practitioner Signature
Clinical Supervisor Signature
P.O.P.S Scoring in Practice - 4
4 month girl who has had a chesty cough and coryzal for 2 days with reduced feeding
Born at 35/40
Observations recorded
She appears alert but has some recession and use of accessory muscles
HR: 189
RR: 76
Temp: 37.9
Sa02: 88%
Using the P.O.P.S system, what score would you give this patient?
Sa02: 88%
Describe the actions would you take now.
Date
Practitioner Signature
Clinical Supervisor Signature
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Clinical Knowledge
Assessment
Practiced /
Discussed
Reviewed
(Date)
Demonstrates
Knowledge
(Date, Initials)
Practiced /
Discussed
Reviewed
(Date)
Demonstrates
Knowledge
(Date, Initials)
Practiced /
Discussed
Reviewed
(Date)
Demonstrates
Knowledge
(Date, Initials)
Identifies factors that can
influence paediatric P.O.P.S
assessment
Demonstrates age specific
assessment techniques with
regards to a child’s physical
emotional developmental
Demonstrates a focused
assessment on each of the
following:
 neurological
 respiratory
 cardiovascular and
circulatory
Recognition of a sick and
injured child
Demonstrates a structured
approach to the recognition of the
seriously ill and injured child
Able to carry out a rapid clinical
assessment sequence to identify
serious illness in a child
Demonstrates the ability to score
the child appropriately depending
on their condition
Seeks clinical assessment/review
as P.O.P.S determines
POPS
Attended in-house training
session
Successfully completed
scenario’s
Demonstrates ability to break
down score
Demonstrates the ability to
integrate score into the triage
process
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This completed and signed training package is evidence that you are
competent at calculating an accurate POPS score and facilitating the
appropriate course of action in response to the score generated. A copy will
be held in your paediatric training file and a second copy should kept by
yourself as evidence for your KSF.
Practitioner’s signature:
Clinical Supervisors signature:
Date:
Revised by: Rebecca Herring (Junior Sister) Denise Goddard (Senior Sister
Emergency Department, Sherwood Forest Hospitals)
Devised and Acknowledgments to: Helen Rolle (ACENP) and Samantha
Thompson (Derby Children’s Emergency Department. Karen Liggins
(Education Practice Development Sister, Emergency Department, Leicester)
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Critical Analysis Reflection
The scenarios undertaken are designed to allow practice at using the
Paediatric Observation Priority Scoring system. Below is a space to reflect
upon your own practice. This is an optional activity. Included is an action plan
for further personal development. You may wish to use this as evidence
towards your continuing professional development and your appraisal.
Reflection
Action Plan
Action required
Method
Completion date
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References
Department of Health (2001) Working together – Learning together.
Advanced Paediatric Life Support: The Practical Approach (2010) Temporary
Version 5th Ed, BMJ Publishing Group. (Wiley-Blackwell). PP 7-8.
Further reading
M. Thompson, N. Coad, A. Harnden, et al (2009) How well do vital signs
identify children with serious infections in Paediatric care? Downloaded from
adc.bmj.com on May 29, 2010 - Published by group.bmj.com
Kathy. N. Shaw, Richard. M. Ruddy, Cody. S. Olsen, Kathleen. A. Lillis,
Prashant. V. Mahajan, J. Michael. Dean, James. M. Chamberlain, (2009).
Pediatric Patient Safety in Emergency Departments: Unit Characteristics and
staff perceptions. Paediatrics official journal of The American Academy of
Paediatrics’.
Faculty of Emergency Nursing- www.facultyofemergencynursing.org
Tume. Lyvonne & Bullock. I, (2004). Early warning tools to identify children at
risk of deterioration: a discussion. Paediatric Nursing. vol 16. no8. October
2004.
Royal College of Nursing (2004). Services for Children and Young People;
Preparing Nurses for Future Roles. London: RCN.
Royal College of Paediatrics and Child Health (2007) Services for Children in
Emergency Departments Available at: http:www.rcpch.ac.uk/HealthServices/Emergency -Care
www.spottingthesickchild.com
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