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Implementing Pediatric Surviving Sepsis Campaign Guidelines: Improving Compliance With Lactate Measurement in the
Anisha Mazloom1, Stacey M Sears1, Erin F Carlton1,2
1Division of Pediatric Critical Care Medicine, University of Michigan Medical School, Ann Arbor, MI.
Critical Care Explorations
|April 27, 2023
Summary
A quality improvement initiative increased compliance with timely lactate measurement in pediatric intensive care unit (PICU) patients with severe sepsis/shock. This helps meet 2020 guidelines for better sepsis outcomes.
Area of Science:
- Pediatric critical care medicine
- Quality improvement science
- Infectious disease management
Background:
- The 2020 pediatric Surviving Sepsis Campaign (pSSC) guidelines recommend lactate measurement within the first hour for severe sepsis/shock.
- Compliance with this recommendation is crucial for timely diagnosis and treatment of pediatric sepsis.
- Severe sepsis and septic shock in the pediatric intensive care unit (PICU) require prompt management.
Purpose of the Study:
- To enhance adherence to the pSSC guideline for first-hour lactate measurement in PICU-admitted patients with severe sepsis/shock.
- To reduce the time to first lactate measurement in pediatric patients experiencing sepsis onset within the PICU.
Main Methods:
- A structured, single-center quality improvement initiative was implemented in a 26-bed quaternary-care PICU.
- Interventions included forming a multidisciplinary team, educating frontline providers, and implementing a peer-to-peer nursing education program.
- Data were collected from December 2018 to December 2021 for all PICU-onset severe sepsis/shock events.
Main Results:
- Overall compliance with first-hour lactate measurement increased by 24% (from 38% to 47%) after interventions.
- The mean time to the first lactate measurement decreased by 46% (from 175 to 94 minutes).
- Statistical process control analysis showed a 55% improvement in the mean time to lactate measurement (from 179 to 81 minutes).
Conclusions:
- A multidisciplinary quality improvement approach successfully reduced the time to first lactate measurement in pediatric sepsis.
- These improvements represent progress towards the 60-minute lactate measurement target recommended by the pSSC.
- Enhanced compliance is vital for evaluating the impact of pSSC guidelines on pediatric sepsis morbidity and mortality.
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