Multidisciplinary teams determine improvement opportunities and effectively educate staff members to advance sepsis detection and treatment.
By Christine Bush
Time to recognition. Time to action. Time is critical in reducing pediatric sepsis mortality rates, and those dedicated to improving detection and treatment time are seeing success in a variety of areas. Two award-winning, children's hospital nurses share how education combined with a team approach to analyzing critical action is helping their hospitals improve sepsis outcomes.
Mary Kate Abbadessa, RN, clinical nurse specialist-fellow at Children's Hospital of Philadelphia (CHOP), worked with a team that designed a two-tiered alert embedded in the triage pathway already in use by nurses. The first section helps recognize if the patient has a heart rate faster than normal for his or her age or low blood pressure and triggers a series of more assessments.
If the nurse documents additional risk factors, a second alarm goes off signaling the patient is at risk for sepsis. In one year, CHOP staff saw the identification of sepsis patients in the emergency department (ED) improve from 83 percent to 96 percent.
Part of the CHOP multidisciplinary team that created the alerts included data analysts. "Including analysts at the table from the beginning helped us understand our needs," Abbadessa says. "With the added information we could measure successes, drive change and really begin to be effective."
Time to delivering IV antibiotics is another focus in the effort to reduce pediatric sepsis mortality rates. Guidelines call for delivering IV antibiotics and fluids within one hour of identification. Andrea Cowan, RN, Primary Children's Hospital in Salt Lake City, helped a multidisciplinary team fine tune actions in the ED following identification of a patient at risk for sepsis. The team studied improvement opportunities for IV access and fluid delivery times.
Primary Children's now calls a Code Sepsis to alert the IV team a sepsis-risk patient needs immediate attention. Median IV access time averages 12 minutes. Staff members also worked with pharmacy representatives to change infusion times for sepsis patients from 30 minutes to five minutes.
"Success begins with identifying the problem," Cowan says. "We reviewed any charts that had been included in our sepsis process. We looked at what happened and got feedback from clinicians to help define actions and education plans that could make the process go smoother."
Cowan reports 95 percent of patients included in the process are getting IV antibiotics and fluids within one hour.
Reaching outside hospital walls
Because of their work, the Sepsis Alliance named Abbadessa and Cowan recipients of the 2018 Erin's Campaign for Kids Nursing Awards. Spreading awareness is a rewarding experience for Cowan. "People are hearing about the decreasing mortality rates and want to make sure a patient can access our alerts at any point in their hospital stay. It's exciting that we can show other people the process we've created."
Abbadessa and the CHOP team began their improvement work in the ED and PICU, but are now helping other units including hematology oncology, medical/surgical, cardiac ICU, and NICU adopt sepsis quality improvements. News of their success is reaching beyond their organization. "The outpatient world is knocking at our door asking when is it their turn," Abbadessa says. "We've talked with a nurse from Australia about our improvements. I never anticipated having the opportunity to influence outside the hospital."
To learn more about what children's hospitals are doing to detect sepsis, watch Pearls and Pitfalls in the Recognition and Treatment of Pediatric Sepsis. This webinar, presented by the Improving Pediatric Sepsis Outcomes Collaborative in partnership with Sepsis Alliance, featured clinicians from CHOP and Seattle Children's discussing how to recognize variances in the clinical presentation of sepsis between children and adults and how this is critical to improving outcomes.
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