035 - Improving pediatric sepsis through high reliability and safety culture

Publication Number: 35.5180

Rhea M. Vidrine, Kentucky Children's Hospital, Wilmore, KY, United States; Stephanie R. George, Kentucky Children's Hospital University of KY, Georgetown, KY, United States; Tariq Chaudry, University of Kentucky, Lexington, KY, United States; Michael Simmons, UK HealthCare, Lexington, KY, United States; AJ Jeck, Kentucky Children's Hospital, Richmond, KY, United States; Wesley T. Smith, University of Kentucky College of Medicine, Lexington, KY, United States; Caryn Sorge, Kentucky Children's Hospital, Lexington, KY, United States; Emily Eichinger, Kentucky Children's Hospital, Versailles, KY, United States

Background: Pediatric sepsis is the leading cause of morbidity and mortality worldwide. Early identification and resuscitation are critical for decreasing mortality. Guidelines recommend fluid resuscitation within 20 minutes of sepsis recognition and antibiotic administration within 60 min. Integrating error prevention techniques and high reliability safety practices into sepsis huddles may lead to improved sepsis care.

Objective: The primary aim is to improve compliance with evidence-based sepsis treatment, specifically to decrease the mean time to first antibiotic after a sepsis huddle initiation by 30% from 84 to 59 min and to decrease the mean time to first rapid fluid bolus initiation by 30% from 64 min to 45 min.

Design/Methods: Sepsis huddles were implemented in Kentucky Children’s Hospital in November 2020. Huddles focused on compliance with sepsis treatment. Time to fluid resuscitation and antibiotic administration remained above goal, so quality improvement methodology was used to improve sepsis care. Key drivers included, utilization of sepsis algorithm, staff understanding of sepsis treatment goals, standardization of sepsis huddles, effective team communication, and foundation of culture of safety. Interventions that drove change include Solution for Patient Safety culture of safety training for all, revamped sepsis huddle process utilizing culture of safety error prevention techniques, dedicated rapid response nurse to ensure standardization of workflow and compliance with treatment guidelines, and multi-modal education for trainees and nurses on the standardized sepsis huddle workflow, error prevention tools, and sepsis treatment. Time to fluid resuscitation and first antibiotic administration after sepsis huddle initiation were displayed on statistical process control charts.

Results: The mean time to antibiotic administration after a sepsis huddle initiation improved from 84 min to 48 min (Fig 1). The mean time to fluid bolus administration improved from 64 min to 23 min (Fig 2). A machine learning predictive analytics tool has been incorporated in additional Plan-Do-Study-Act cycles and pediatric mortality has decreased, though the reduction is not yet statistically significant (Fig 3).

Conclusion(s): Integration of culture of safety tactics and shared situational awareness has led to improved sepsis care, and may lead to improved pediatric sepsis outcomes.

Figure 1.
PAS X chart abx.pdfX-chart showing the mean time to antibiotic administration improved from 84 min to 48 min after interventions.

Figure 2.
PAS x chart fluid.pdfX-chart showing the mean time to fluid administration improved from 64 min to 23 min after interventions.

Figure 3.
PAS mortality u chart.pdfU-chart showing sepsis related mortality index

Figure 1.
PAS X chart abx.pdfX-chart showing the mean time to antibiotic administration improved from 84 min to 48 min after interventions.

Figure 2.
PAS x chart fluid.pdfX-chart showing the mean time to fluid administration improved from 64 min to 23 min after interventions.

Figure 3.
PAS mortality u chart.pdfU-chart showing sepsis related mortality index