1 Quality Improvement: Using the Electronic Medical Record to Identify Sepsis in Pediatric Patients in the Emergency Department Matthew J. Hulsman Department of Nursing, The University of South Alabama NU450: Leadership and Management Roles for Professional Nursing Dr. Susan G. Williams July 27, 2020 Summer 2020
2 Quality Improvement: Using the Electronic Medical Record to Identify Sepsis in Pediatric Patients in the Emergency Department Pediatric sepsis and early identification of symptoms have been shown to increase the chances of survival. Quality improvement initiatives have been geared towards understanding sepsis symptoms in children as they differ in many cases from an adult presentation. Much is yet to be studied, but early detection is a key factor in achieving good patient outcomes (Despins, 2017). Weiss et al. (2014) suggest using clear clinical pathways, staff education, electronic order sets, and decrease time to antibiotics can reduce mortality in the pediatric patient. With the implementation and advancement of the electronic medical record (EMR), some have employed its use as a means to identify and track patients presenting with, or developing, sepsis. This paper will discuss the use of the EMR as a tool to identify pediatric sepsis in its early stages as a quality of care initiative, thus leading to good patient outcomes in the pediatric emergency department. The Problem with Sepsis A patient with a systemic infection that has entered the bloodstream is known to be septic. In 2009, sepsis was ranked the sixth highest reason for adult admissions with 836,000 hospital stays; and sepsis totaled approximately $15.4 billion in hospital costs in the same year (Elixhauser et al., 2011). Aitken et al. (2011) report sepsis as one of the highest causes of death in infants and children. Sepsis is an emergency and emergency care should be initiated immediately to prevent progression into septic shock (Rhodes et al., 2017). A delay in initial antibiotic treatment past three hours increased the chance of mortality in the pediatric patient (Weiss et al., 2014). Early detection is key to better outcomes and intravenous antibiotics given in the first hour after
3 recognition of sepsis is considered a best practice (Rhodes et al., 2017). Hynes-Gay et al. (2002) report the most significant way to reduce mortality is to identify sepsis before it progresses, and Jeffery et al. (2014) suggest that effective treatment of sepsis can only begin after identification of the condition. Thus, nurse recognition is a key factor in the identification and timely treatment. The pediatric patient has the potential to be more problematic in detection due to presentation and findings such as vital signs. Hypotension is a late indication of sepsis in children and lack of recognition of vital signs changes, per Sepanski et al. (2014), can cause delays in treatment where time is vital to achieving good patient outcomes.
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