Paediatric Emergency Department.
Paediatric Observation Priority Score
(POPS)
Teaching Package
Practitioner
Clinical Supervisor
Contents
Introduction & Purpose
Scope
Staff Knowledge
Documentation
Self Assessment
CRT and BP
Actions
POPS scenarios
Critical Analysis Reflection
Clinical Knowledge
What next & final sign off
References & Further Reading
UHL Paediatrics Observation Scoring Tool
Paediatric Normal vital signs
Revised by
Consultation with
Page 3
Page 3
Page 4
Page 4
Page 5
Page 6
Page 6
Page 7 & 8
Page 9
Page 10
Page 11
Page 12
Appendix one page 13 & 14
Appendix Two page 15
Karen Liggins (Education Practice Development
Sister. Emergency Department. Leicester.)
Damian Roland.
Devised and Acknowledgment to:
Helen Rollé (ACENP) & Samantha Thompson
(Children’s Emergency Department, Derby)
University Hospitals of Leicester NHS Trust.
Emergency Department
Paediatrics observation priority scoring. (Version 3- 12/11)
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Introduction
Amongst the 6 million children presenting to urgent and emergency care settings
each year there are some very sick children, and detection requires good risk
stratification. However the majority of parents seeking advice need only
reassurance and minimal intervention.
The Paediatric Observation Priority Score (POPS) is a physiological and
observational scoring system designed for use by health care professionals of
varying clinical experience.
Within the Paediatric Emergency Department the POPS score has been in a
developmental format since 2009 and was implemented into the department’s
standard paperwork in 2010. It is intended that that POPS will improve standards
of care, encourage improved communication both within and outside of the
department, assist in the early recognition of clinical deterioration in ill children
and facilitate the discharge and re-direction of patients who require primary care
services.
As a part of the NHS learning strategy it is reported that “continuing professional
development must be part of the process of lifelong learning for all healthcare
professionals – its purpose is to help professionals care for patients…” (DOH
2001).This document provides both a teaching and resource tool. It will be
reviewed following a pilot programme and changed if necessary to reflect
changing needs.
It is intended that this document can be utilised by all members of nursing,
medical and multidisciplinary staff who perform clinical observations as a part of
patient management to teach and demonstrate evidence of clinical knowledge in
performing and using the POPS system.
Purpose
To ensure all staff who perform nursing observations within the Children’s
Emergency Department are able to use the POPS to be able to both recognise
and respond appropriately to children with serious illness, clinical deterioration
and also provide support in determining which children may be re-directed or
discharged to primary care. POPS is a clinical decision aid however and its use
should never supersede the clinical judgement of the person using it – senior
advice should be sought in all cases of uncertainty.
Scope
It is intended that this guideline will be applicable for all staff who undertake
clinical observations for patient management.
University Hospitals of Leicester NHS Trust.
Emergency Department
Paediatrics observation priority scoring. (Version 3- 12/11)
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Staff Knowledge
All staff who undertakes clinical observations within the Paediatric Emergency
Department will demonstrate the required knowledge and understanding
necessary to use the Paediatric Observations Priority Scoring tool, to be able to
manage patient care safely. A teaching package accompanied by teaching
sessions will be supplied and clinical knowledge will be tested before certification
in the use of POPS is given.
For staff working within the Children’s Emergency Department, Paediatric
Observation Priority Scoring training will be carried out in conjunction with Triage
teaching and competency assessment.
Documentation
All Paediatric Observation Priority Scores will be documented on designated trust
documentation and will form a part of all regular routine clinical observations.
All actions relating to Paediatric Observation Priority scores will be appropriately
recorded within nursing documentation.
Audits will be carried out on a regular basis and reported back to the Paediatric
Management Team.
University Hospitals of Leicester NHS Trust.
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Paediatrics observation priority scoring. (Version 3- 12/11)
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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 Advanced Paediatric Life Support
Manual which can be accessed within your clinical area and also 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
Oxygen
Saturations
Breathing
(work of
breathing)
AVPU
Gut Feeling
Other
Pulse
Respiratory
Rate
Temperature
University Hospitals of Leicester NHS Trust.
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Features if
score 1
Features if
score 2
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 if 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 or 1
Could this child be seen by Urgent Care?
POPS <3
These children must have a set of discharge
observations
POPS 4-6
Is a senior aware that this child is in the department.
This child must have a repeat set of observations
every hour.
POPS 7+
Has a senior seen this patient?
Should this child be in Resus/HDU?
University Hospitals of Leicester NHS Trust.
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P.O.P.S Scoring in Practice - 1
Triage Scenario
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.
Competency Achieved
Date
Practitioner Signature
Clinical Supervisor Signature
P.O.P.S Scoring in Practice - 2
Triage Scenario
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 appears 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?
Competency Achieved
Date
Practitioner Signature
Clinical Supervisor Signature
University Hospitals of Leicester NHS Trust.
Emergency Department
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P.O.P.S Scoring in Practice - 3
Triage Scenario
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.
Competency Achieved
Date
Practitioner Signature
Clinical Supervisor Signature
P.O.P.S Scoring in Practice - 4
Triage Scenario
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?
Describe the actions would you take now.
Competency Achieved
Date
Practitioner Signature
Clinical Supervisor Signature
University Hospitals of Leicester NHS Trust.
Emergency Department
Paediatrics observation priority scoring. (Version 3- 12/11)
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Sa02: 88%
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
University Hospitals of Leicester NHS Trust.
Emergency Department
Paediatrics observation priority scoring. (Version 3- 12/11)
Completion date
9
Clinical Knowledge
Assessment
Self-Assessment
Practiced /
Discussed
Reviewed
(Date)
Demonstrates
Knowledge
(Date, Initials)
Self-Assessment
Practiced /
Discussed
Reviewed
(Date)
Demonstrates
Knowledge
(Date, Initials)
Self-Assessment
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
emothional 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
University Hospitals of Leicester NHS Trust.
Emergency Department
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What Next?
Now that you have completed this booklet, you need to be signed off as
competent below. You must take two photocopies and forward one onto the
Education Practice Development Team who can up date your training record. The
second copy must be passed onto your line manager for your personal file.
Assessment Criteria
Name & Signature of Assessor
& Date
All work book questions are answered &
discussed satisfactorily
I understand that I have now reached the standard required to
assess Paediatrics using the POPs tool throughout demonstration
in this work booklet.
Signature:
Name:
Date:
University Hospitals of Leicester NHS Trust.
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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 Peadiatrics.
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
University Hospitals of Leicester NHS Trust.
Emergency Department
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Appendix one
University Hospitals of Leicester NHS Trust.
Emergency Department
Paediatrics observation priority scoring. (Version 3- 12/11)
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Time:
Sats
Breathing
AVPU
Gut
Feeling
HH:MM
Observation
Exit
Observations
Score
University Hospitals of Leicester NHS Trust.
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Other
Pulse
Respiratory
Rate
Temp
Total
Score
Priority
A child’s observations.
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 advise 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
University Hospitals of Leicester NHS Trust.
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