Development of an urgent access algorithm for children with sepsis
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Joan E. Mackenzie, MS, RN, CPNP, CPEN; Emily Greenwald, MD; Amanda Stump, MSN, MSW, APRN, CPNP; Carter Smith, BS; James Thomas, BSN, ENA, CPEN; Nicole Ernst, RN, MS, CPNP-AC/PC; Halden F. Scott, MD
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Purpose: Our institutional sepsis leadership team sought to improve key drivers to influence outcomes in pediatric sepsis. We prioritized the key drivers of outcomes locally through site specific process mapping, a sepsis Kaizen event, review of data and sentinel cases. We identified difficult vascular access in a subgroup of patients as a barrier to achieving resuscitation/stabilization in our emergency/urgent care settings. Our objective is to improve sepsis care by hastening time to vascular access and subsequently hastening time from order to delivery of broad spectrum antibiotics. We sought to do this by: 1. Creating a standardized time-based algorithm for obtaining access 2. Promoting use of alternative access methods through method specific tips/tricks sheets and education.
Design: This is a quality and process improvement project using QI methodology to identify our key drivers and define our objectives.
Setting: We are an academic regional pediatric trauma center with 6 satellite emergency departments and urgent care locations with 170,000 visits per year.
Participants/Subjects: All staff were trained on the use of the urgent access algorithm for pediatric patients with presumed sepsis and difficult vascular access.
Methods: A multidisciplinary quality Improvement team met to create an “Urgent Access Algorithm”. A fishbone diagram identified barriers. A discussion among multidisciplinary local experts led to a decision to promote administration of intramuscular cephalosporin if IV/IO access is not achieved within 60 minutes. While emphasizing flexibility of methodology based on resources, the algorithm also firmly emphasized a fixed timeline in sepsis. To support algorithm execution and encourage varied access options an associated tips/tricks work tool was created for each access method: existing central line, PIV, US guided PIV, EJ & IO. Multipronged communication/education strategies were deployed to all care team members including procedure room signage, education at site-specific huddles, skills practice and inclusion in sepsis awareness activities.
Results/Outcomes: The process resulted in creation of an algorithm with educational/support resources to facilitate its use. Key features are time-based recommendations and inclusion of varied access options with an intramuscular option for antibiotic delivery when other access attempts fail. Data are being collected on time to access, access type and time to antibiotics pre/post intervention. Preliminary data show an increase in the use of alternate access types as well as an improvement in the metric of time from order to delivery of broad spectrum antibiotics.
Implications: This process sought to improve pediatric sepsis care by improving concordance with rapid vascular access through algorithm creation. Adoption/performance were enhanced by tailoring to site specific resources, tip/trick work tools as well as an energetic educational campaign that included all care team members.
Emergency Nursing 2019. Held at the Austin Convention Center, Austin, Texas, USA
Type | Poster |
Acquisition | Proxy-submission |
Review Type | Abstract Review Only: Reviewed by Event Host |
Format | Text-based Document |
Evidence Level | Quality Improvement |
Research Approach | N/A |
Keywords | Pediatric Sepsis; Urgent Access; Quality Improvement |
Name | Emergency Nursing 2019 |
Host | Emergency Nurses Association |
Location | Austin, Texas, USA |
Date | 2019 |
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