Sepsis Huddle
Sepsis Huddle Project
Dayagnis Rodriguez
Overview
References
Epidemiology
Definitions
St. John’s Sepsis Surveillance Tool
Plan
Do
Sepsis Pathway
Sepsis Huddle Algorithm
Sepsis Response Documentation Checklist
Study
Act
Epidemiology
Leading cause of hospitalizations and death
Among top 10 causes of death in children younger than 10 years
Over 75,000 pediatric sepsis hospitalizations/year
Nearly 10,000 pediatric deaths/year due to sepsis
Estimated $4.8 billion in healthcare cost for children with sepsis each year
Definitions
Infection: Clinical examination, imaging and/or laboratory tests consistent with infectious process
Sepsis: Life-threatening organ dysfunction caused by a dysregulated host response to infection.
Septic Shock: Subset of sepsis with circulatory and cellular/metabolic dysfunction associated with a higher risk of mortality.
St. John’s Sepsis Surveillance Tool
Has been live since 2018
Uses algorithm that silently screens for sepsis every 5 minutes
Uses age-based metrics
Triggers when at least two SIRS and one Organ Dysfunction metric is met
Plan
The staff will follow a sepsis pathway when the St. John’s Sepsis alert shows up in Cerner and decide if a Rapid Response Sepsis should be called for the patient or not.
Problem: There is a delay in identifying patients that may be septic.
Population: Infants, Children, and Adolescents.
Time: The project will be worked on for three weeks
I hope this plan leads to an efficient way of delivering broad spectrum antibiotics and fluids in a timely manner
Do
The St. John’s Sepsis alert will show in Cerner and the nurse has 15 minutes to inform the physician. At this time, the primary nurse, the charge nurse, the physician, and the parents will have a sepsis huddle in the room. They will be doing and physical assessment along with looking at the labs and vitals and decide if it is a real sepsis alert. If it is not a real sepsis the patient will continue to be monitored and the nurse and physician will write their notes of the event on the system. On the other hand, if it is decided that it is a real sepsis, then a rapid response sepsis is called, and the team has 10 minutes to show up. This team will include pharmacy, PICU nurse, phlebotomy, IV team, and intensive care fellow. The difference between any rapid response and the sepsis one is that the pharmacy will show up with the antibiotics and fluids for rapid administration of the two. They will prepare the medications at bedside according to the patient’s height and weight. After administration of the medications, if the patient is still requiring more boluses of fluids, they will go to PICU for further evaluation. If the interventions work, then the patient stays on the floor and continues with monitoring.
Sepsis Pathway
Sepsis Pathway
Screening
Sepsis Huddle
Sepsis/Septic Shock Power Plan
Assess for fluid overload
More fluids vs begin pressors
Fluid Resuscitation 10-20 mL/kg
Sepsis Huddle Algorithm
Vitals/Screen Criteria- St. John’s Sepsis
Discern Alert- Notify provider within 15 mins.
SEPSIS HUDDLE: Unit’s response team goes in patient’s room (Primary RN, Charge RN, Provider)
Provider to fill out Sepsis Huddle
Documentation
Discuss patient with parent/caregiver- do they have concerns?
Review scores (PEWS, RS)
Assess patient as a team
Nursing to fill out Acute Event Form
NEXT
Deliberate on huddle outcomes:
• Infection: suspected or proven (not sepsis)
• No criteria met for Sepsis or Infection (no actions needed)
• Meets criteria for Sepsis or Septic Shock activate Rapid Response SEPSIS
Follow SEPSIS Pathway
Rapid Response SEPSIS: Team must report within 10 minutes
• Pharmacy
• Phlebotomy
• IV team
• PICU
Nursing fill out Acute Event Form
Sepsis Response Documentation Checklist
Study
Mock codes will be performed to make sure that the project works, and all the staff is aware of the process and are able to implement it as exercised.
Act
The project was successful. The rapid response team showed up in less than 10 minutes and antibiotics and fluids were given within the hour of the sepsis alert.
Dissemination
A poster was created with all the information and an Inservice will be done around the units of the hospital. Also, a flyer with the pathway and different phases of the project will be available in every unit’s bulletin board.