Children's Hospitals Today - Summer 2016 - 19
result, early pediatric sepsis often travels
in a clinical care team's blind spot-and it
travels fast in a child's small body.
To combat it and to drive early
detection, diagnosis and treatment,
experts say children's hospitals should
start by creating a culture of teamwork
and empowerment. "Enabling the
institution, regardless of provider or
venue, to take actionable and effective
steps is going to be important to make
these outcome changes," Macias says.
"And everyone has to be part of that
team, including administrators and
clinicians. It doesn't matter what
subspecialty you're in or whether
you're a nurse or a physician, you've
got to function as a team within
the infrastructure across the entire
institution if you're going to make a
difference." To learn more about getting
involved in efforts to combat sepsis,
see "Working together to save lives,"
on page 20.
"Huddle up" for sepsis
Boston Children's Hospital set out to
make a difference when it launched a
clinical care project to improve antibiotic
timing in children with concern for
sepsis. Elliot Melendez, M.D., associate
director of safety and quality, Division
of Medicine Critical Care, Division of
Emergency Medicine at Boston Children's
Hospital, says when he and his team
looked at antibiotic timing in children
in intensive care units who showed early
signs or concern for sepsis, they were
taking three hours on average to give
an antibiotic. Based on adult literature,
the current acceptable measure is to
administer antibiotic within an hour
of signs or concern for sepsis. So, the
team went to work on its process with
the goal of reducing the time it takes to
recognize signs or concern for sepsis and
the time it takes to act. "One of the initial
interventions was the implementation of
a 'sepsis huddle,'" Melendez says. "Just
like a football team, we get together and
we huddle, and we say we are worried
about this patient or we're not worried
about this patient, and if not, we can shut
off the process."
The huddle takes place in front of the
patient's bed space with the bedside
nurse, charge nurse, attending, fellow,
resident and nurse practitioner. If the
team agrees there is a concern for sepsis,
they assign roles and priorities, including
obtaining timely blood cultures and
antibiotics from the pharmacy, and they
create a detailed follow-through plan.
The team then combined this huddle
with a sepsis trigger tool. "This tool
enchances recognition of children at risk
for sepsis-if a child has a new fever
and a new tachycardia, and he or she has
certain risk factors like a central line,
immunodeficiency, or chronic illness-
this is someone we should worry about a
lot quicker," Melendez says. "When we see
these signs, it should trigger the huddle."
The implementation of the sepsis
recognition tool and the path for improved
communication through the sepsis huddle
in the PICU has reduced the time to
administer antibiotics to children with
concern for sepsis from 180 minutes to
71 minutes-more than a 50 percent
reduction. The processes are also driving
down ICU length of stay (LOS), Melendez
says. Before these initiatives, the average
ICU LOS at Boston Children's Hospital was
25 days. Now, it's just eight days. To learn
more about Boston Children's sepsis work,
read their 2015 Pediatric Quality Award
entry at childrenshospitals.org/award.
Empowering the front lines
Five years ago, Macias says there was
reluctance to make the diagnosis of
sepsis due to a lack of empowerment
on the front lines and hesitance to
escalate care to colleagues. Since then,
Texas Children's Hospital has instituted
electronic medical record trigger tools
for decision support. So, if a member of
the care team suspects sepsis and the
Septic shock requires one of the
following to be present:
Rapid pulse
Circulatory collapse
Nausea and vomiting
SEVERE SEPSIS
∙ feeble pulse
∙ pale or discolored skin
∙ shortness of breath
∙ shivering
SEPTIC SHOCK
Multi-organ Dysfunction Syndrome
MODS
∙ abnormal heart functions
∙ noticeably lower amounts
of urine
∙ confusion or weakness
DEATH
Significant blood
pressure drop
CHILDREN'S HOSPITAL S TODAY Summer 2016
19
http://www.childrenshospitals.org/award
Table of Contents for the Digital Edition of Children's Hospitals Today - Summer 2016
Contents
Children's Hospitals Today - Summer 2016 - Cover1
Children's Hospitals Today - Summer 2016 - Cover2
Children's Hospitals Today - Summer 2016 - Contents
Children's Hospitals Today - Summer 2016 - 2
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