Dataset Information

A Quality Improvement Project Focused on Improving First Dose Antibiotic Timeliness for Pediatric Intensive Care Unit Patients with Severe Sepsis.

ABSTRACT: Recommended time to start administration of first dose antibiotics for sepsis patients is 60 minutes from time 0. Institution-specific data revealed that only one-quarter of severe sepsis patients were meeting this goal when measured from the time of provider order entry. Reliance on a pneumatic tube system for first-dose antibiotic delivery was deemed largely responsible for this finding. This project aimed to increase the percentage of pediatric intensive care unit patients with severe sepsis receiving first dose antibiotics within 60 minutes of provider order entry to ?50%. Methods:Baseline data were collected from May to June 2018 and resulted in the development of a new "antibiotic champion" process, which we piloted for 1 week in early August 2018. The primary outcome measure was the cumulative percentage of patients meeting the 60-minute goal as measured from provider order entry to start of antibiotic administration. A key secondary endpoint was the median time in minutes from provider order entry to antibiotic administration. Results:We included 14 patients in baseline data analysis and 16 patients in the pilot. The overall percentage of patients receiving antibiotics within 60 minutes of order entry increased from 29% to 75% (P-value: 0.026). The median time from provider order entry to antibiotic administration decreased by 36.5 minutes [baseline: 84.5 (range 58.8-117) versus pilot 48 (range 32-65), P-value: 0.0017]. Conclusion:The antibiotic champion process significantly increased the total percentage of severe sepsis patients meeting the 60-minute goal and decreased the median time to first-dose antibiotic administration for pediatric intensive care unit patients.

SUBMITTER: Keul R

PROVIDER: S-EPMC7056285 | biostudies-literature | 2020 Jan-Feb

REPOSITORIES: biostudies-literature

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A Quality Improvement Project Focused on Improving First Dose Antibiotic Timeliness for Pediatric Intensive Care Unit Patients with Severe Sepsis.

Keul Ryan R Rodriguez Jordan J Coleman Ariel A Yadav Prerna P

Pediatric quality & safety 20200122 1

Recommended time to start administration of first dose antibiotics for sepsis patients is 60 minutes from time 0. Institution-specific data revealed that only one-quarter of severe sepsis patients were meeting this goal when measured from the time of provider order entry. Reliance on a pneumatic tube system for first-dose antibiotic delivery was deemed largely responsible for this finding. This project aimed to increase the percentage of pediatric intensive care unit patients with severe sepsis ...[more]

PMID: 32190795

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Project description:Abstract Preterm birth is a risk factor for early experience of pain. Despite advances in neonatal care, evidence‐based knowledge of the importance of adequate pain management and strong international guidelines for assessment and treatment of neonatal pain, only 10% of sick term and preterm infants were assessed for pain and stress on a daily basis. The aim of this quality improvement (QI) project is evaluation of implemented guidelines for pain assessment and management, and increased parental involvement in a Norwegian single‐family room NICU. Method: The different steps of the project entailed translation of the English version of COMFORTneo, development and implementation of guidelines with flowcharts for pain management, and pain assessment certification of the interprofessional staff. Part two of the project is supervision of the interprofessional staff in parental involvement in stress‐ and painful procedures. Our study showed that one year after implementation, 88.8% of the COMFORTneo assessments were performed according to the pain management guidelines. The staff used the flowcharts to assess, treat and reassess pain and stress. There was a high interrater reliability with linearly weighted Cohen's kappa values ranging from 0.81 to 0.95, with a median of 0.90. In addition, our study showed increased parental involvement in procedures, from 50.3% before to 82.3% after the quality improvement project. The success of this quality improvement project is explained by systematic use of flowcharts and implemented guidelines for pain management, interprofessional collaboration, and cultural change agents. Theoretical lectures and practical bedside supervision to interprofessional staff increased parental involvement in stress‐ and painful procedures. The aim of this quality improvement (QI) project is evaluation of implemented guidelines for pain assessment and management and increased parental involvement in a Norwegian single‐family room (SFR) NICU. The main steps were translation and implementation of the COMFORTneo scale and development of flowcharts and pain management guidelines. The study showed high compliance to guidelines, high COMFORTneo assessment inter‐rater reliability, and increased parental involvement in procedures.

Project description:Background: Survivors of pediatric sepsis often develop new morbidities and deterioration in quality of life after sepsis, leading to a need for improved follow-up for children who survive sepsis. Objective: To implement a follow-up system for pediatric sepsis survivors in a pediatric health system. Methods: We performed a retrospective case series of patients treated for sepsis from October 2018 through October 2019 in a pediatric intensive care unit in a quaternary children's hospital, and describe implementation of a follow-up system for sepsis survivors. Program planning started in 2017 with multidisciplinary meetings including physical, occupational, and speech therapists, teachers, neuropsychologists, and coordinators from other survivorship programs (neonatology, stroke, and oncology). In 2018, a workshop was held to consult with local and national experts. The Pediatric Sepsis Survivorship Program launched in October 2018 led by a nurse coordinator who met with families to educate about sepsis and offer post-discharge follow-up. Patients with high pre-existing medical complexity or established subspecialty care were referred for follow-up through existing care coordination or subspecialty services plus guidance to monitor for post-sepsis morbidity. For patients with low-moderate medical complexity, the nurse coordinator administered a telephone-based health-assessment 2-3 months after discharge to screen for new physical or psychosocial morbidity. Patients flagged with concerns were referred to their primary physician and/or to expedited neuropsychological evaluation to utilize existing medical services. Results: Of 80 sepsis patients, 10 died, 20 were referred to care coordination by the program, and 13 had subspecialty follow-up. Five patients were followed in different health systems, four were adults not appropriate for existing follow-up programs, four remained hospitalized, and four were missed due to short stay or unavailable caregivers. The remaining 20 patients were scheduled for follow-up with the Pediatric Sepsis Program. Nine patients completed the telephone assessment. Four patients were receiving new physical or occupational therapy, and one patient was referred for neuropsychology evaluation due to new difficulties with attention, behavior, and completion of school tasks. Conclusions: Implementation of an efficient, low-cost pediatric sepsis survivorship program was successful by utilizing existing systems of care, when available, and filling a follow-up gap in screening for select patients.

Dataset Information

A Quality Improvement Project Focused on Improving First Dose Antibiotic Timeliness for Pediatric Intensive Care Unit Patients with Severe Sepsis.

Publications

A Quality Improvement Project Focused on Improving First Dose Antibiotic Timeliness for Pediatric Intensive Care Unit Patients with Severe Sepsis.

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