P77 Trigger happy: recognising sepsis in children's emergency department using in- situ simulation

• Published in: BMJ simulation & technology enhanced learning Vol. 3; p. A69
• Main Authors: Dursley, Jo, Davis, VM
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group LTD 01.11.2017
• Subjects: Antibiotics; Children & youth; Sepsis; Simulation
• ISSN: 2056-6697
• DOI: 10.1136/bmjstel-2017-aspihconf.141

Background The Children's Emergency Department (CED) at the Royal Derby Hospital sees over 36 000 children a year. In 2015, the UK Sepsis Trust Paediatric Sepsis tool was introduced. Following a serious case review in 2016, it was identified further training and education about sepsis was required for all staff. The department also purchased a sepsis trolley so that everything required for the management of the child with sepsis was ready to enable early intervention of triggering the Paediatric Sepsis tool. An in situ simulation was developed to see if a child who deteriorated later in their attendance would trigger use of the Paediatric Sepsis tool and would timely escalation and treatment occur? Would staff use the sepsis trolley? Project Description Three in situ simulations were undertaken over a three month period and followed a real time patient journey through CED using a paediatric high fidelity manikin and simulated parent. The scenario was designed so that at triage the child would not show signs of sepsis but would deteriorate later in the attendance. Outcomes In all three simulations, deterioration was recognised and the Paediatric Sepsis tool triggered. This included prompt escalation for senior review by consultant, preparation and administration of antibiotics and first fluid bolus happening within an hour of triggering, antibiotics commenced within 20 min from recognition of sepsis. During the first scenario it was found that the sepsis trolley had not been restocked and items were missing. It has been included in the equipment daily checklist in the department, ensuring it is ready to use. On the two subsequent simulations it was fully stocked. Participating staff completed a generic in situ simulation feedback form. 11 forms were received from 1 HCA, 5 Staff Nurses, 1 Sister, 2 Junior Doctors and 2 Consultants, with results below. Conclusions and Recommendations Staff demonstrated recognition of sepsis, timely escalation and treatment using the Paediatric Sepsis tool and the sepsis trolley. Using in situ simulation allowed identification of the issue with the stocking of the trolley without compromising patient safety. Since the in situ simulations occurred, the Paediatric Sepsis tool has been reviewed and modified. We plan to continue the programme of sepsis in situ simulation to include the paediatric wards as well as CED, to coincide with the introduction of sepsis trolleys in the ward areas and re-launch of the Paediatric Sepsis tool. Reference . nice.org.uk/guidance/ng51 2016 . sepsistrust.org Sepsis: recognition, diagnosis and early management. July 2016 . Paediatric Sepsis 6 version 11.1 August 2015 in collaboration with the UK Sepsis Trust Paediatric Group