G460(P) Emergency antibiotic administration to children at high risk of sepsis – using the golden hour

• Published in: Archives of disease in childhood Vol. 104; no. Suppl 2; p. A186
• Main Authors: Richens, NC, Clay, C
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group LTD 01.05.2019
• Subjects: Age; Antibiotics; Bone marrow; Chemotherapy; Children; Coding; Computer programs; Departments; Medical instruments; Meropenem; Patients; Pediatrics; Performance assessment; Population; Risk factors; Sepsis; Stem cells
• ISSN: 0003-9888; 1468-2044
• DOI: 10.1136/archdischild-2019-rcpch.445

AimsThe importance of early recognition and antimicrobial intervention in paediatric patients developing clinical evidence of sepsis is now well-established. While the concept of a ‘golden hour’ is a subject of current debate, protocols for patients at risk of sepsis focus upon the administration of antibiotics within 60 min of presentation to an emergency department. The aim of this study was to review the antibiotic administration for children presenting to a specialist paediatric emergency department with one or more age-appropriate observational parameters matching SIRS criteria and an additional risk factor for sepsis, defined as; current oncological chemotherapy, aplastic anaemia, post-stem cell/bone marrow therapy, or home parental nutrition via a central venous catheter.MethodsA search of all the patients presenting to a specialist paediatric emergency department over a 1 year period between 2017–2018 with one or more age-appropriate initial observational parameters matching SIRS criteria was performed. The search was performed using PatientFirst software and identified a cohort of 945 patients. This population was searched for criteria identifying them as meeting the high risk criteria above. These identifiers included high risk coding within the software and subsequently coded diagnoses which matched the high risk criteria. This yielded a population of 59 patients (n=59). The scanned and physical hospital records for this population were reviewed with respect to the choice prescription time, and administration time of sepsis-protocolised antibiotics to assess performance according to a ‘golden hour’ target.ResultsThe notes of 59 patients were reviewed. All 59 patients received an appropriate IV antibiotic as per the hospital protocol (Tazocin or Meropenem). The mean time from prescription of antibiotics to administration was 29.7 min(range −5–80). The mean time from ED booking to antibiotic administration was 59.66 min(range 21–152). 58% of the patients received antibiotics within the golden hour.ConclusionIn conclusion, our study demonstrated surprising findings in a population receiving protocolised antibiotic therapy for high risk of sepsis. Clinician perception of this differed significantly and this is worthy of further open discussion.