Implementing a Sepsis Bundle to Improve Recognition of Pediatric Sepsis

Abstract

Problem: At a Mid-Atlantic Pediatric Intensive Care Unit (PICU), there is a lack of adherence to a sepsis pathway, which leads to delayed and under-recognized pediatric sepsis and a delay in medical treatment of pediatric sepsis. In the target PICU in 2022, seventy percent of patients who had a documented positive sepsis diagnosis experienced a delay in either recognition or intervention. Early recognition of pediatric sepsis improves the time to intervention and decreases morbidity and mortality. Methods: The best practice alert (BPA) was developed using an algorithm to detect sepsis metrics from patient clinical data entered into the electronic health record (EHR). Eight providers and fifty nurses were educated on the sepsis bundle, including the BPA trigger, initiating a sepsis huddle, and standardized documentation. Nursing initiates a sepsis huddle if the BPA triggers as a result of signs of sepsis, and the patient’s provider participates and documents the outcomes of the huddle in the EHR. Project aims were achieved through chart audits of sepsis huddle documentation, support from PICU stakeholders, and communication through staff meetings facilitated weekly by the EHR builder. Results: Delays in the BPA production within the EHR impacted the sepsis bundle implementation. Before BPA usage, 86% of patients diagnosed with sepsis had a sepsis huddle and documentation in the EHR (n=7). Following BPA implementation, 43% (n=31) of staff adhered to the sepsis pathway. Conclusion: Findings suggest that with the implementation of a sepsis bundle in the PICU, there has been an increase in the number of sepsis huddles and documentation due to staff education. After implementing the BPA, results-focused on using the BPA rather than positive sepsis huddles and documentation alone. Due to the delay in the BPA production, no evidence suggests implementation has increased sepsis huddles and documentation in the PICU. Keywords: Sepsis, PICU, BPA, electronic health record, sepsis huddle, documentation