Anisha Mazloom, MD
University of Michigan C. S. Mott Children's Hospital
Ann Arbor, MI
Disclosure information not submitted.
Stacey Sears, DNP, CPNP-AC
Nurse Practitioner
C.S. Mott Children's Hospital, University of Michigan, United States
Disclosure information not submitted.
Erin Carlton, MD, MSc
University of Michigan C. S. Mott Children's Hospital
Ann Arbor, MI
Disclosure information not submitted.
Katherine Bates, MD, MSHP
Clinical Associate Professor
C.S. Mott Children's Hospital, University of Michigan, United States
Disclosure information not submitted.
Heidi Flori, MD
Associate Professor
University of Michigan C.S. Mott Children's Hospital
Ann Arbor, MI
Disclosure information not submitted.
Title: Implementing Pediatric Surviving Sepsis Campaign Guidelines: Improving Measurement of Lactate
Introduction: The 2020 Pediatric Surviving Sepsis Campaign (pSSC) guidelines include a recommendation to obtain a lactate measurement during the first hour of resuscitation for septic shock. We aimed to improve compliance with this first hour lactate sampling recommendation in pediatric septic shock patients admitted to our Pediatric Intensive Care Unit (PICU).
Methods: Severe sepsis/shock cases originating in our PICU from 11/2018 to 4/2021 were identified using our institution’s Improving Pediatric Sepsis Outcomes (IPSO) database. The onset of sepsis was approximated by the recently validated IPSO definition of “time zero.” We obtained divisional consensus that lactate measurement would be the first pSSC recommendation to target, followed by a pre-intervention current state analysis and creation of a multi-disciplinary local improvement team. Countermeasures were first implemented in 12/2020 including education programs and badge card reminders targeting front line providers and nurses. Monthly PDCA cycles were utilized to monitor for improvement.
Results: The pre-intervention (11/2018-12/2020) cohort includes 115 cases (median first lactate 1.4 mmol/L, range 0.2-21.0 mmol/L). The current post-intervention (1/2021-4/2021) cohort includes 16 cases (median first lactate 1.75 mmol/L, range 0.7-12.7 mmol/L). Almost all patients had lactate measurements obtained: 95.7% (110/115) pre- and 87.5% (14/16) post-intervention, with improvement in obtaining these lactates within the 60-minute timeframe: 38.3% (44/115) pre- and 50.0% (8/16) post-intervention. Any intervention (fluid bolus, antibiotic, or pressor) was administered after lactate measurement in 65.2% (75/115) of pre- versus 50.0% (8/16) of post-intervention cases. Overall, since countermeasure implementation average monthly compliance has improved from 37.9% to 55.1%.
Conclusions: We report initial success in use of our local IPSO database to align our PICU sepsis management practices with a key first hour pSSC recommendation. To effect this change, we established divisional consensus and created a local multidisciplinary pSSC team to establish countermeasures and monitor PDCA cycles. Future directions include ensuring sustainability of this success and extrapolating this methodology to support additional pSSC recommendation-based projects.