BCCH Inpatient Sepsis
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Transcript of BCCH Inpatient Sepsis
Cathy Masuda, RN, MN Quality & Safety Leader BCCH
Inpatient Sepsis :Identification &
Mitigation
Background
Patient Condition Worsens
Recognition of deterioration by
“someone”
Assistance sought
Medical Intervention
Management by most appropriate
resources
Relocation to appropriate care area if required
DELAY
INCONSISTENT
INCONSISTENT
DELAY
DELAY
INCONSISTENT
DELAY
12 Severe Sepsis cases reviewed (2009) showed 0% compliance with 100% of all recommended treatment aspects within recommended timeframes.
Background
• 2010-11 development of Pediatric Sepsis Guidelines (Provincially adopted through CHBC)
http://childhealthbc.ca/?drawer=Sepsis%20Guidelines
Current State
Current State:Challenges
Current State:Challenges
Background: Developmentally delayed, medically complex school-age child . High-utilizer of system. Long-term inpatient due to complicated post-operative recovery.
Overview:
Discussion:Even with a robust system in place we still encounter those one-off situations. Some contributing factors in this situation:
• RN bias about patient due to “knowing” the patient. Therefore, did not escalate IV start urgency… resulted in delay in antibiotics and IV bolus
• RN not aware of sepsis screening protocol (even though prompt onflowsheet). Also charting done on a notepad and then transcribed so ability to pick up PEWS deterioration (as in EARLY WARNING) doesn’t happen with late entry charting
• Once medical team responded, the junior resident also made assumptions about a surface contamination and response being typical of this patient
• Covering attending would not cover for another surgeon’s patients due to current workload and MRP was not in town. On-site medical team covered after urgent call
• RN did not escalate surgical team lack of response concerns (Escalation Protocol exists) in a timely manner
Patient Condition Worsens
Recognition of deterioration by
“someone”Assistance sought
Medical Intervention
Management by most appropriate
resources
Relocation to appropriate care area if required
Delay
Delay
Delay
Current State
Future State
Provincial • Standardized PEWS Process
throughout the province• Process includes:
– standard work for identification, notification and mitigation/escalation of care for the deteriorating child.
– situational awareness– sepsis screening– daily management
National• In partnership with Canadian
Association of Pediatric Health Centers looking at pediatric sepsis
• Goal is to establish national standards for prevention, recognition and treatment of sepsis (Next slide)
• Currently conducting a PDSA testing a national screening tool throughout select sites in the province
NOTE: Any work being done through BCPSQC regarding Pediatrics should be done in partnership with CHBC & BCCH
Infection
SepticShock
SevereSepsis
Sepsis
INFECTION SEPSIS SEVERE SEPSIS
SEPTIC SHOCK
Prevention Hand hygiene practices, Vaccinations, NI improvement bundles (VAP, CRBSI, CAUTI, SSI), IC Guidelines, Antibiotic stewardship, Auditing (IC & NSQIP)
PAIRS response process, Antibiotic stewardship, HH, NI bundles, IC bundles
PAIRS response process (ICU consult), Antibiotic stewardship, HH, NI bundles, IC bundles
HH, NI bundles, IC bundles
Recognition/Dx Sepsis Guideline, Sepsis Screening, PEWS & Situational Awareness (PAIRS)
Advanced lab dx, Research at CFRI; Screening, PAIRS
PAIRS, Advanced lab dx,
PAIRS, Advanced lab dx,
Tx/Follow-up Sepsis Guideline, Antibiotic stewardship
Order set, Antibiotic stewardship
Order set, Antibiotic stewardship,
Order set, Antibiotic stewardship, Code Blue, ECLS
Trajectory of septic shock & known interventions