| Popis: |
Background: Hematology/oncology (H/O) patients have been screened for sepsis since 2013 at a pediatric hospital. Using sepsis screening (Ss) tool, results, and addition of organ dysfunction screening (ODs), decision tree (DT) was designed (Fig. 1) for nurses to identify sepsis and intervene. Objectives: Positive Ss require multiple assessments by nurses and H/O physicians creating sepsis alert fatigue. By implementing DT, calls to H/O physicians for sepsis alerts could be reduced 24% without increasing misses of patients with sepsis. Methods: Patients with Ss < 4 considered negative; Ss > 4 positive. ODs < 2 considered negative, = 2 at risk, > 2 positive for sepsis. In 2016, Ss were performed on H/O patients upon admission, status change, or nurse concern. May 2017, DT was implemented on H/O. From 5/5/17 to 8/30/17 Ss and ODs were conducted every 12 hours or with status change (Fig. 2). Results: Design period: 1,457 Ss (n = 1,393); 200 Ss positive (n = 180); 8 Ss, ODs < 2 (n = 44); 152 Ss, ODs = 2 (n = 139); and 0 Ss, ODs > 2. Implementation period: 6,502 Ss (n = 512); 1,647 Ss positive (n = 292); 293 Ss, ODs < 2 (n = 72); 1,351 Ss, ODs = 2 (n = 265); and 30 Ss, ODs > 2 (n = 14). See Figure 3 for pediatric intensive care unit (PICU) transfers during design/implementation periods. Conclusions/Implications: During implementation, calls were reduced to H/O physicians by 17.5% (ODs < 2). Most patients were ODs = 2. Recommendations included calling physician only if nurse was concerned of patient’s status with OD = 2. DT with addition of ODs has increased awareness of sepsis and communication between transferring providers. We have not found an increase in sepsis misses requiring transfer to PICU. |
