Children's Hospitals Today - Summer 2016 - 20

TAKING ACTION Working together to save lives In June, children's hospitals participating in the Improving Pediatric Sepsis Outcomes collaborative began mobilizing to target improvement across all levels of care. The goal is to reduce sepsis deaths and hospitalonset severe sepsis by 75 percent. "This will accelerate discovery and evidence around whether something works by having pools of organizations involved," says Charles Macias, M.D., MPH, chief clinical systems integration officer, Texas Children's Hospital, and national co-chair of the collaborative. "It's about standardization and best practices." According to Toni Wakefield, M.D., pediatric hospitalist at Dell Children's Hospital, one institution by itself won't see the volume of sepsis patients to know which way of screening is better. "If we can come up with a combination of markers and vital signs that have good sensitivity and specificity-that would be the Holy Grail. And we're only going to get that if we collaborate." While information and best practices will be shared among all children's hospitals and the industry at large during key milestones, participating hospitals will have access to:  Bundles and feasible measures based on the best evidence  A data infrastructure to customize and simplify submission and performance tracking  Virtual learning, interaction activities and workshops  Training, tools and resources Hospitals may still sign on to participate. Visit childrenshospitals.org/ sepsiscollaborative for more information. 20 CHILDREN'S HOSPITAL S TODAY Summer 2016 EMR data back that up, that person is more comfortable and confident about raising a red flag for possible sepsis. "It empowers nurses, physicians and respiratory care practitioners to say, 'I need to act on this, because it's not just me,'" Macias says. "Here's a medical calculation showing this person is at risk. And, that has changed our culture." That culture change has also led to a change in outcomes at Texas Children's. These changes include a 50 percent decrease in the amount of time it takes to get from the first diagnosis to the administration of antibiotics, and a 9 percent decrease in PICU-related sepsis mortality in the last five years. "In the end, we can look at process measures, but what is most compelling is the number of lives we save," Macias says. The adult dilemma When it comes to sepsis, the definitions, data and guidelines for care all hail from the adult world, which only further complicates sepsis care in pediatrics. "Children are different, so the adult work is not going to be applicable as is," Wakefield says. "It needs modification for a child's physiology." UNC Hospitals in Chapel Hill, N.C. is not only taking that into account, but it's operating in an inverted universe-where pediatric sepsis care at UNC Children's Hospital helps inform care on the adult side of the system. As one example, pediatrics is used to giving fluid resuscitations to children with sepsis in a weight-based bundle, taking the child's physiology into account. However, emergency room or inpatient nurses for adults are accustomed to giving a set number of liters per patient, according to Tina Schade Willis, M.D., associate chief medical officer for quality at UNC Hospitals, which includes UNC Children's Hospital. "Our pediatric nurses have been able to help the adult side with how to think about measuring fluid in a weight-based way," Schade Willis says. "We try to collaborate as much as we can to help each other." Code Sepsis UNC Children's Hospital also served as the June 2015 launching ground for the system's new Code Sepsis program before taking it live with adults. Just like with a Code Blue, any staff member or nurse can pick up the phone and use the same number they would to call a code. "They can say, 'I have a Code Sepsis in Room X,'" Schade Willis says. "That will activate our pediatric or adult rapid response team, depending on whether it's an adult or pediatric patient." When the rapid response team arrives, they understand this is likely a sepsis patient and are ready to use the sepsis bundle, she says. There's also a Code Sepsis pharmacist for adults and for pediatrics who is notified to speed time to administer antibiotics. In the PICU, an "informal" Code Sepsis approach-a direct outreach to the most senior ICU physician versus calling the operator-requires that physician to assess the patient at the bedside immediately. If the patient is deemed septic, they go through the formal Code Sepsis pathway. "The lesson learned was, if you use that phrase, even if you're not calling through a formal system, it puts everyone in the mindset you actually have to get this done quickly, and it requires a team coming together," Schade Willis says. "Just like a trauma or any other code scenario." This team-based approach has reduced the time it takes to get blood cultures and administer antibiotics and the first fluid resuscitation from several hours down to, in some cases, 10 minutes. The key to the team's success, Schade Willis says, is incorporating sepsis in routine emergency measures training and holding ongoing large-scale sepsis simulations. "Simple low-fidelity, hands-on practice has been the most important thing beyond an childrenshospital s.org http://www.childrenshospitals.org/sepsiscollaborative http://www.childrenshospitals.org/sepsiscollaborative http://www.childrenshospitals.org

Table of Contents for the Digital Edition of Children's Hospitals Today - Summer 2016

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