Pediatric Critical Care Medicine:
May 2014 - Volume 15 - Issue 4_suppl - p 203
Hospital-Wide Implementation Of Time Sensitive Clinical Decision Support For Pediatric Septic Shock
Heidersbach, R.S.; Sinclair, K.; Barreiro, A.; Flori, H.; Plant, J.
Background and aims: Since 2011, we have been researching optimal implementation strategies for time-sensitive clinical decision support (CDS) in the management of pediatric patients meeting internationally accepted surviving sepsis campaign (SSC) criteria. A sepsis assessment tool and SSC clinical practice guideline (CPG) have been created and hospital-wide education implemented.
Aims: To test the efficacy of our CDS strategies to date, four investigators facilitated interviews and focus groups with nursing (n= 13) and clinician faculty (n= 9) from the emergency, inpatient, day hospital, hematology/oncology and critical care departments.
Methods: Interviews were recorded, transcribed and independently reviewed and themes generated and reconciled.
Results: Each of the focus groups identified four prominent themes. Physician themes included 1) Improved familiarity with the guidelines, 2) More timely and aggressive management of patients with sepsis, 3) Concern that the internationally accepted criteria are too sensitive, resulting in over-identification of patients, 4) Continued room for education using multiple modalities. Nursing themes included 1) Need for ongoing education/training, 2) Improved recognition and treatment of septic patients although concern for over-identification given the current definitions, 3) Continued need to encourage a hospital-wide culture facilitating early activation of the 'rapid responses' necessary, 4) Potential for the guidelines to improve communication and nursing confidence.
Conclusions: Physician and nursing groups independently identify potential and current benefits of our sepsis assessment tool and SSC CPG. Both recommend expanding hospital-wide education. Future development of pediatric sepsis ‘triggers’ using electronic health record prompts must be carefully chosen given the great proportion of patients presenting with sepsis-like conditions and risk of 'alert fatigue.’