When kids are in the hospital, their bodies are already vulnerable by the very nature of their illness or injury. This puts them at increased risk for sepsis, the body’s extreme immune response to a bacterial infection that gets into the blood. Sepsis is a medical emergency and requires urgent treatment.
CHoR is among a group of 47 children’s hospitals across the country working together in the prevention and timely diagnosis and treatment of sepsis through the Improving Pediatric Sepsis Outcomes collaborative. While a staggering 75,000 kids are admitted per year to hospitals across the country with sepsis, the collaborative’s goal is to reduce sepsis deaths and hospital-onset sepsis by 75 percent by the year 2020.
“Being part of the IPSO collaborative is one of the ways we’re teaming up with other children’s hospitals to advance children’s health care here in Central Virginia and across the country,” said Jeniece Roane, interim vice president for children’s services. “Three of our experts will take a lead role in the collaborative’s next meeting, sharing CHoR’s approach to efficient sepsis diagnosis and treatment.”
The presentation is titled “It’s time to huddle” and is based on the huddle initiative implemented by our clinical teams earlier this year.
The golden hour
“We call it the golden hour,” said Tracy Lowerre, RN, MS, CPN, nurse lead for the sepsis initiative at CHoR. “When sepsis is suspected, you need to run labs, administer a rapid fluid IV and give the first round of antibiotics within the first hour. There’s a lot that needs to happen in a short amount of time.”
The one-hour timeframe comes from research that shows the longer you wait to address sepsis, the more adverse and serious effects a patient can have. In the huddle approach used by our clinical team, the nurse screens a patient who shows signs of potential sepsis. The first indicator is a fever or particularly low temperature. When a temperature that is out of normal range is paired with an abnormally high heart or respiratory rate or an elevated white blood cell count, the nurse pulls a medical provider in for a sepsis huddle.
Once a virus, post-op fever and other potential conditions are ruled out, the rapid response team, including a pediatric intensive care nurse, physician and respiratory therapist, is called in to begin the sepsis testing and treatment.
“Our nursing team has done an excellent job implementing the sepsis screening and huddle,” said Jon Silverman, MD, emergency medicine specialist and sepsis physician lead. “With this approach, our goal is to catch sepsis early and treat it immediately. Working together, our pediatric team, including departments across the hospital from the NICU to the ER, consistently beats the goals for treating sepsis with the first round of antibiotics within the hour.”
The huddle initiative includes reminder cards that nurses carry with their identification badges, and a detailed huddle form that helps in collecting information and guiding the step-by-step process. We are also piloting a system that will page the charge nurse when an antibiotic is ordered to ensure the process remains in motion in the event that the patient’s regular nurse is tending to another patient.
Since the process began in April 2017, 98 huddles have been conducted that resulted in treatment plans, and 26 have involved pulling in the rapid response team.
Spreading the word
In addition to the huddle presentation, Tracy Lowerre will co-facilitate professional work groups at the national sepsis collaborative meeting for sharing best practices on topics such as family engagement, data analysis and others. Our sepsis team also provided professional and community education on World Sepsis Day in September to raise awareness of the condition, warning signs and urgency of treatment.
Infections must be treated right away. If there is any suspicion of sepsis, take action and seek the help of a medical professional. Every minute counts.
Know the symptoms – save a life.
S – Shivering, fever or feeling very cold
E – Extreme pain or general discomfort
P – Pale or discolored skin
S – Sleepy, difficult to wake or confused
I – “I fear for my life”
S – Shortness of breath