• Article
  • February 8, 2018

The Role of Critical Care Nurses in Improving Pediatric Sepsis Outcomes

Developing systems that support and empower nurses can meet the challenges of providing the right care across the sepsis continuum.

By Darcie Reeson

For two children's hospital nurses, failures to recognize and respond appropriately to sepsis weigh heavily on their minds. But these failures also inspired them to become sepsis advocates.

Beth Wathen, PICU clinical practice specialist at Children's Hospital Colorado, remembers a young oncology patient who exhibited decline over a 12-hour period before dying from untreated septic shock. That was a kick in the gut for Wathen, who was heavily involved in the development of the rapid response team (RRT) in her organization.

"We had just implemented a program that was meant to prevent cases like this," Wathen says. "It was meant to allow teams to call the ICU earlier and intervene when they were concerned about the patient. Our system failed this patient because staff never activated it—they didn't escalate for help."

Wendi Redfern, clinical nurse specialist at Children's Hospital of Wisconsin, was drawn to the complicated condition after caring for children who required long ICU stays as a result of sepsis; some never made it out of the hospital. "Caring for these kids is complex," Redfern says. "They demand a lot of intervention, and it's difficult for nurses to prioritize what tasks need to be done when. So many things need to happen at one time."

Both hospitals have systems to detect sepsis in the emergency department; staff members are trained to act on sepsis suspicions. But it's more complicated in the inpatient setting, where beds are filled with kids with medical complexities who have multiple conditions. Teams may be focused on the original admitting diagnosis, and there's a risk of sepsis in children being missed until the patient deteriorates to a dangerous level. Wathen and Redfern saw this as an area of opportunity in improving sepsis care—with nurses in the lead.

Developing systems that support and empower nurses helps them provide the right care across the sepsis continuum. Register for The Battle Against Sepsis: Nurses Leading Change webinar on Feb. 21 to hear the strategies the two hospitals used to improve awareness and workflows. They include:

  • Implementing an escalation huddle. Nurses should be empowered to call for resources when they have a concern, even if it's not sepsis—there is a reason for the patient's decline.
  • Developing a transportable algorithm white board for resuscitation. Ensure everyone is aware of interventions already given and still needed.
  • Bringing direct care providers to the table when developing workflows. They understand the challenges of beside care and systems that need to change.
  • Reframing thinking to prioritize interventions. Remove barriers to prevent significant delays in the most beneficial treatment.
  • Encouraging multidisciplinary teams. Create a common understanding of needs, from working with nursing resource teams for urgent IV access, to working with their pharmacy to provide antibiotics in the right format.
  • Building a sepsis pathway for action after the alert. Once nurses are alerted to possible sepsis in the EHR, they have instant access to evidence-based guidelines.
  • Creating an internal sepsis awareness campaign. It's important to bring sepsis into people's consciousness, so they automatically ask the question "is this sepsis?"

Wathen says this work is not possible without nurses. "They own a huge chunk of it," she says. "Nurses are at the bedside, aware of subtle changes, talking with families—so we should educate them on the early signs. Their role in the rest of the process is just as critical. We should build in the premise to every process that anybody can escalate any concern and push back is not acceptable."

Sepsis Alliance named Wathen and Redfern—members of CHA's Improving Pediatric Sepsis Outcomes (IPSO) collaborative—the 2017 Erin Kay Flatley Pediatric Nursing Award winners for their sepsis advocacy work.

"There are groups like IPSO, Sepsis Alliance and others that said, 'We need to do better, and let's all work together on it,'" Redfern says. "Because then the learning can be that much faster. When you have a patient with sepsis who comes near death, and he or she walks out the door waving and smiling, there's nothing more powerful than knowing you made a difference with the work you've done."

Send questions or comments to magazine@childrenshospitals.org.