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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.
Insights
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.
Abstract:
The 2020 pediatric Surviving Sepsis Campaign (pSSC) recommends measuring lactate during the first hour of resuscitation for severe sepsis/shock. We aimed to improve compliance with this recommendation for patients who develop severe sepsis/shock while admitted to the PICU.
Design:
Structured, quality improvement initiative.
Setting:
Single-center, 26-bed, quaternary-care PICU.
Patients:
All patients with PICU-onset severe sepsis/shock from December 2018 to December 2021.
Interventions:
Creation of a multidisciplinary local sepsis improvement team, education program targeting frontline providers (nurse practitioners, resident physicians), and peer-to-peer nursing education program with feedback to key stakeholders.
Measurements And Main Results:
The primary outcome measure was compliance with obtaining a lactate measurement within 60 minutes of the onset of severe sepsis/shock originating in our PICU using a local Improving Pediatric Sepsis Outcomes database and definitions. The process measure was time to first lactate measurement. Secondary outcomes included number of IV antibiotic days, number of vasoactive days, number of ICU days, and number of ventilator days. A total of 166 unique PICU-onset severe sepsis/shock events and 156 unique patients were included. One year after implementation of our first interventions with subsequent Plan-Do-Study-Act cycles, overall compliance increased from 38% to 47% (24% improvement) and time to first lactate decreased from 175 to 94 minutes (46% improvement). Using a statistical process control I chart, the preshift mean for time to first lactate measurement was noted to be 179 minutes and the postshift mean was noted to be 81 minutes demonstrating a 55% improvement.
Conclusions:
This multidisciplinary approach led to improvement in time to first lactate measurement, an important step toward attaining our target of lactate measurement within 60 minutes of septic shock identification. Improving compliance is necessary for understanding implications of the 2020 pSSC guidelines on sepsis morbidity and mortality.
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