Helping parents spot the signs of sepsis

Sepsis awareness campaign will help parents and carers of young children recognise the symptoms of sepsis.

A nationwide campaign has been launched to help parents spot the symptoms of sepsis to protect young children and save lives.The campaign is principally aimed at parents and carers of young children aged 0 to 4.

The campaign, delivered by Public Health England and the UK Sepsis Trust, follows a number of measures already taken by the NHS to improve early recognition and timely treatment of sepsis. This includes a national scheme to make sure at-risk patients are screened for sepsis as quickly as possible and receive timely treatment on admission to hospital.

Leaflets and posters are being sent to GP surgeries and hospitals across the country. These materials, developed with experts, will urge parents to call 999 or take their child to A&E if they display any of the following signs:

  • looks mottled, bluish or pale
  • is very lethargic or difficult to wake
  • feels abnormally cold to touch
  • is breathing very fast
  • has a rash that does not fade when you press it
  • has a fit or convulsion

The UK Sepsis Trust estimates that there are more than 120,000 cases of sepsis and around 37,000 deaths each year in England.

Click Here to Download Sepsis Symptoms Poster

Clinical Practice: Using a Best Evidence Sepsis Scoring Tool to Identify and Manage Pediatric Patients With Severe Sepsis in the Emergency Department

Calhoun, C. et al. (2016) Journal of Pediatric Nursing. 31(5) pp. 560-561

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Severe sepsis and septic shock are leading causes of pediatric morbidity and mortality, resulting in prolonged hospitalization and increased healthcare costs. 1,2 Delays in recognition of sepsis, vascular access, and administration of fluids and antibiotics are major barriers within pediatric emergency departments (ED). 3,4 Severe sepsis is defined as symptoms suspicious of infection plus signs of organ dysfunction or tissue hypoperfusion. 5 A sepsis trigger tool at triage can identify vital sign abnormalities of severe sepsis, alert ED resources, and rapidly begin the sepsis protocol. 3 Annually, almost 100,000 pediatric patients present to the ED with signs of severe sepsis. 6.

Using the concept of “PIRO” (predisposition, infection, response, and organ dysfunction), the sepsis tool was adapted to identify pediatric patients at risk for sepsis with signs of infection, age-related abnormal vital signs, and signs of organ dysfunction.

With 5 or greater score (maximum score of 16), a “sepsis alert” was paged. A multidisciplinary team was mobilized: ED nurse, ED paramedic, physician, respiratory therapist, and child life specialist. Using a nurse-initiated pathway, patient was placed on cardiac apnea monitor, pulse oximeter, and oxygen, vital sign monitoring was begun, intravenous (IV) line insertion with lab work was obtained, and weight-based IV fluid bolus was initiated with antibiotics anticipated. Sepsis scores were repeated after interventions or with status changes. An ED sepsis committee was formed to audit charts and educate staff on the sepsis tool.

From January 2014 through April 2015, median times for triage-to-IV fluid bolus improved from 65 to 51 min and triage-to-antibiotic times improved from 137 to 80 min.

With early recognition and treatment of sepsis, ED experienced improved patient mortality rates, shorter hospital stays, and decreased hospital costs. The successes of multidisciplinary interventions, effective communication, increased awareness, and staff compliance have led to decreases in triage-to-bolus and triage-to-antibiotic times. The tool was accurate in identifying severe sepsis; the admission rate for positive sepsis alerts was 60%.

Read the abstract here

Recognising signs of sepsis in children

Health Education England has announced details of a new film Think Sepsis which aims to help health care professionals to spot and respond to the warning signs of sepsis in children.

 

 

The film highlights the key signs that healthcare staff should be looking out for and asks them to think, ‘could this be sepsis’ when assessing and diagnosing patients. Whilst aimed at clinical trainers the film contains valuable information for GPs and other clinicians working across both primary and secondary care.

A prospective quality improvement study in the emergency department targeting paediatric sepsis

Long, E. et al. Archives of Disease in Childhood. Published Online: 31st March 2016

Objective: Quality improvement sepsis initiatives in the paediatric emergency department have been associated with improved processes, but an unclear effect on patient outcome. We aimed to evaluate and improve emergency department sepsis processes and track subsequent changes in patient outcome.

Study design: A prospective observational cohort study in the emergency department of The Royal Children’s Hospital, Melbourne. Participants were children aged 0–18 years of age meeting predefined criteria for the diagnosis of sepsis. The following shortcomings in management were identified and targeted in a sepsis intervention: administration of antibiotics and blood sampling for a venous gas at the time of intravenous cannulation, and rapid administration of all fluid resuscitation therapy. The primary outcome measure was hospital length of stay.

Results: 102 patients were enrolled pre-intervention, 113 post-intervention. Median time from intravenous cannula insertion to antibiotic administration decreased from 55 min (IQR 27–90 min) pre-intervention to 19 min (IQR 10–32 min) post-intervention (p≤0.01). Venous blood gas at time of first intravenous cannula insertion was performed in 60% of patients pre-intervention vs 79% post-intervention (p≤0.01). Fluids were administered using manual push-pull or pressure-bag methods in 31% of patients pre-intervention and 84% of patients post-intervention (p≤0.01). Median hospital length of stay decreased from 96 h (IQR 64–198 h) pre-intervention to 80 h (IQR 53–167 h) post-intervention (p=0.02). This effect persisted when corrected for unequally distributed confounders between pre-intervention and post-intervention groups (uncorrected HR: 1.36, 95% CI 1.04 to 1.80, p=0.02; corrected HR: 1.34, 95% CI 1.01 to 1.80, p=0.04).

Conclusions: Use of quality improvement methodologies to improve the management of paediatric sepsis in the emergency department was associated with a reduction in hospital length of stay.

Read the full article here

Disparities in Adherence to Pediatric Sepsis Guidelines across a Spectrum of Emergency Departments

Kessler, D. et al. The Journal of Emergency Medicine. Volume 50, Issue 3, March 2016, Pages 403–415.e3

Background: Each year in the United States, 72,000 pediatric patients develop septic shock, at a cost of $4.8 billion. Adherence to practice guidelines can significantly reduce mortality; however, few methods to compare performance across a spectrum of emergency departments (EDs) have been described.

Objectives: We employed standardized, in situ simulations to measure and compare adherence to pediatric sepsis guidelines across a spectrum of EDs. We hypothesized that pediatric EDs (PEDs) would have greater adherence to the guidelines than general EDs (GEDs). We also explored factors associated with improved performance.

Methods: This multi-center observational study examined in situ teams caring for a simulated infant in septic shock. The primary outcome was overall adherence to the pediatric sepsis guideline as measured by six subcomponent metrics. Characteristics of teams were compared using multivariable logistic regression to describe factors associated with improved performance.

Results: We enrolled 47 interprofessional teams from 24 EDs. Overall, 21/47 teams adhered to all six sepsis metrics (45%). PEDs adhered to all six metrics more than GEDs (93% vs. 22%; difference 71%, 95% confidence interval [CI] 43–84). Adherent teams had significantly higher Emergency Medical Services for Children readiness scores, MD composition of physicians to total team members, teamwork scores, provider perceptions of pediatric preparedness, and provider perceptions of sepsis preparedness. In a multivariable regression model, only greater composite team experience had greater adjusted odds of achieving an adherent sepsis score (adjusted odds ratio 1.38, 95% CI 1.01–1.88).

Conclusions: Using standardized in situ scenarios, we revealed high variability in adherence to the pediatric sepsis guideline across a spectrum of EDs. PEDs demonstrated greater adherence to the guideline than GEDs; however, in adjusted analysis, only composite team experience level of the providers was associated with improved guideline adherence.

Read the abstract here