Planning and preparation

Consider the following questions when planning your implementation:

Do you have organisational support including medical and nursing management and/or executive sponsorship?
Do you have senior clinical support and engagement?
Have you identified a medical and nursing lead to drive and champion this change?
Have you engaged other teams that may be impacted by this change such as pharmacy?

Assign 6 to 12 months to implement the sepsis pathway including PDSA cycles, educating staff, and collecting and reviewing evaluation metrics. This will help ensure the Pathway is implemented effectively and becomes a sustainable part of your department’s core business.

Use the Readiness Self-Assessment Checklist [DOCX 23.22 KB] and the following resources to support the implementation.

Identify sepsis champions

Identify ‘champions’ from multiple disciplines (nursing, medical, pharmacy) and levels of seniority (senior leaders, frontline clinicians) who have a special interest in paediatric sepsis.

These staff must have an enthusiastic attitude towards driving improvements and will facilitate the successful implementation of the Pathway. This will include promoting the screening tool to facilitate early recognition of sepsis and delivery of the sepsis bundle of care, providing education at the point of care, addressing issues efficiently, and providing feedback to the wider team and stakeholders. These champions will be the faces of the implementation team in your facility/department and you could make them identifiable with a special t-shirt, lanyard or badge. Unit, department and executive support is also essential for the implementation.

The national Sepsis Clinical Care Standard recommends all healthcare services allocate a Sepsis Care Coordinator Role. See the Sepsis coordination: Roles and responsibilities factsheet for guidance on allocating roles and responsibilities to support quality improvement and coordination of care for sepsis at a health service level.

Design files for identification labels

Paediatric Sepsis Design Files for Lanyards, ID cards, Badges, Labels (QH staff only)

Identify the need for a pathway and collect baseline data

It is important to communicate why the Pathway is needed and how this will impact your area. Start with some baseline measurements specific to your department or facility to help increase understanding, and communicate the current clinical approach to sepsis and the experience of children and families.

Use the Data Collection Tool and liaise with your Health Information Service (HIS) or Business Intelligence (BI) teams to identify cases of sepsis at your facility. Review these cases to determine:

How often is sepsis recognised?
Do patients receive best practice treatment?
Is care appropriately escalated, when needed?

The Paediatric Sepsis Knowledge Survey can also be used to assess clinicians knowledge of paediatric sepsis and the factors that impact on how they recognise, escalate and manage paediatric sepsis.

Review the results with your team and present these findings to other clinicians and hospital management to support implementation of the Pathway. Understanding this baseline will make it easier to determine where and when you see improvement.

Use the Office 365 Forms application to create an online version of the Paediatric Sepsis Knowledge Survey and share it with staff electronically and with a QR code. This will make it easier to compare results before and after implementation.

Data collection tools

Establish governance and reporting lines

It is important to establish governance channels and reporting lines before implementation. This will help ensure the Pathway is implemented successfully.
Governance for the Paediatric Sepsis Pathway should include:

executive buy-in and support for the project. It is recommended the reporting end point be the Director of Medical Services and the Director of Nursing Services.
reporting to the Executive Director Medical Services and Executive Director Nursing Services, usually through the Directors and Nurse Unit Managers of the services involved in the change
collaboration with all units involved in the implementation including adult services (medicine, surgery, intensive care unit), emergency departments and paediatric services as well as local patient safety and quality teams.

This will help ensure sepsis remains a key focus for hospital executive and collaboration occurs across relevant departments.

Operational governance for the Pathway should also be considered. This will allow you to state the policies and procedures related to improving paediatric sepsis screening, care and treatment and ensure these are supported and followed. The structure and support of these groups will enable your facility to achieve best practice in sepsis care.

Recommendations for operational governance:

Involve a breadth of affected stakeholders (including consumers)
Identify paediatric medical and nursing champions for every area that will use the Pathway
Involve accreditation committees such as the Standard 8 Committee Recognising and Responding to Acute Deterioration. Most hospitals have an active Standard 8 Committee which includes stakeholders affected by sepsis pathways: medical emergency teams, intensive care units, inpatient teams, emergency departments, Antimicrobial Stewardship (AMS) and infectious diseases. These committees are well placed to review cases, collect and review data, and escalate safety concerns if they arise. This committee often reports to a patient safety director, directors of involved services and the executive. A paediatric subcommittee could also be considered.
Establish a Sepsis Pathway Committee or Working Group involving the previously mentioned stakeholders, patient safety and infectious diseases. This committee could review adult and/or paediatric cases, collect data, escalate concerns if they arise, and share learnings and feedback with clinicians. A paediatric subcommittee could be considered.
Attend the Close Observation and Mortality and Morbidity (M&M) meetings – these groups may discuss sepsis cases and review data, share learnings and provide recommendations
Ask for sepsis to be added as a standing agenda item for these committees and groups.
Close Observation and Mortality and Morbidity (M&M) meetings – these groups may discuss sepsis cases and review data, share learnings and provide recommendations
Search, review, update and share any local policies related to sepsis including training and education materials
Review your facility’s audit strategy for sepsis. How are audits conducted for sepsis, who is responsible for completing these audits and is it part of patient safety and quality audit schedules?

Statewide networking structures will evolve as the pathways are introduced more widely. These may include Clinical Excellence Queensland Clinical Networks and Patient Safety and Quality Improvement Service.

Engage and communicate with stakeholders

You have now identified the need for a Paediatric Sepsis Pathway in your service and established governance structures to support implementation and sustainability.

Use the baseline data you have sourced as well as learnings from other facilities to identify and discuss the benefits, barriers or risks associated with implementation.

Use Sepsis Key Communication Messages (PDF) (QH staff only), Plan for Engaging Stakeholders to help you communicate the need for a pathway to relevant stakeholders.

It is critical to effectively engage and communicate with all stakeholders early to motivate and support the change. This can be achieved through meetings, in-services, face-to-face conversations, sepsis champion representation at safety and quality meetings, regular reports or presentations, and education sessions.

Be creative – provide incentives for attendance at key meetings (e.g. cater for events, hold a project launch morning or afternoon tea).