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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Children's Hospitals Today - Summer 2016 - Cover3
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