After implementation, the team will need to ensure ongoing awareness and sustainability. Common barriers may include staff turnover, project fatigue and competing priorities.

Sustainability means building on the hard work that has already been completed and continuously improving. It is a collective responsibility and the greatest impact for children will come from using the Pathway to screen, recognise and treat sepsis.

To ensure sustainability, start to answer these questions now:

• What is your plan to ensure improvements are not lost?
• How will you ensure ongoing and continuous improvement?
• What is your plan to continue with measurement and evaluation processes?
• Have you tested the new processes during evening and night shifts, and where staffing levels and patient acuity may vary?
• What is your plan to ensure all new staff are trained and understand your local processes?

Sustainability Guide

Use the Sustainability Guide (PDF) and the below strategies to improve the recognition and management of paediatric sepsis at your facility.

Measure and evaluate

You will need to collect data before and after implementation to measure changes in practice and evaluate the outcomes.

Quarterly audits after implementation are recommended to confirm your improvements have been sustained. Audits and reports could:

• compare the process, outcome and/or balancing measures before and after implementation (e.g. percentage of sepsis cases that used the Pathway, cases with timely blood culture collection, cases where antimicrobial was delivered within the specified timeframe). You can use the Data Collection Tool and liaise with your HIS or BI teams to assist with this process.
• measure and evaluate your performance against ACHS and the Sepsis Clinical Care standards. Refer to the National Sepsis Clinical Care Standard Appendix B: Indicators to support local monitoring (PDF) for details on sepsis indicators and how to collect and calculate to support local quality improvement activities.
• complete a Sepsis Clinical Care Standard Self-Assessment to assess your facilities progress towards implementing key elements of the Sepsis Clinical Care Standard. The self-assessment tool can be used when establishing a new sepsis program, or to support the delivery and continual improvement of an existing sepsis program.
• compare Paediatric Sepsis Knowledge Survey results before and after implementation.
• review all level 1 and 2 RISKMAN reports.
• establish incident notifications with patient safety.

Report progress and share learnings

• Share the audit results with your team to provide opportunities for positive feedback, reflection and learning.
• Evaluate the outcomes and impacts of implementing the Pathway with your stakeholders – use data to tell the story (e.g. There was a X% increase in staff confidence in managing sepsis, there was a Y% decrease in length of stay before and after the implementation).
• Continue regular reporting through local committees and governance channels such as Standard 8 committees.
• Celebrate success stories with your teams.
• Present your results at a conference or in a poster.
• Share your progress and learning with QPSP to support continual improvement of the Pathway. Email: paediatricsepsis@health.qld.gov.au

Embed into standard processes

• Create a sepsis kit that sits on the resus trolley in your area. It could include a copy of the Pathway and blood culture bottles to assist in prompt management of sepsis.
• Create a sepsis code to initiate a huddle for children where sepsis is suspected. Research has demonstrated early recognition and escalation of care to the multidisciplinary team improves outcomes. Involving the right team early in the process will improve time metrics and streamline care.
• Ask for the Paediatric Sepsis Pathway to be added as ongoing agenda item to regular meetings such as the Paediatric Working Group, Close Obs meetings, M&M, Standard 8.
• Print out sepsis labels and stick these on charts or patient boards behind beds to facilitate discussions at handover.

Sepsis labels

• Could it be sepsis labels
• I am on sepsis pathway labels

Conduct regular training and education

Conduct regular educational activities to increase knowledge and sustain awareness of paediatric sepsis.

Consider mandatory training at orientation or within 12 weeks of commencement using existing courses and platforms such as Recognising and Responding to Acute Deterioration, Optimus CORE, Clinical Review Meeting education, other clinical training or required training for your HHS matrix.

Integrating this information into existing education frameworks for your department or facility will ensure sustainability.

Other education strategies

• Include sepsis resources and links in medical and nursing orientation materials for junior doctors, interns, registrars, clinical nurses, and registered and enrolled nurses
• run monthly, simulation-based sessions using the Optimus BONUS sepsis simulation package
• Request all clinicians complete the Optimus PRIME Sepsis module eLearning course
• Coordinate regular sepsis awareness sessions and include local cases and learnings to create realistic scenarios and enhance understanding
• Attend Retrieval Services Queensland (RSQ) sepsis education sessions
• Access and share free CPD/CME accredited lectures from the Australian Sepsis Network library and listen to leading sepsis experts from around the world
• Share and watch webinars and skills station videos from Sepsis Education (updated regularly)
• Run in-service or grand rounds sessions with focused updates
• Undertake formalised training programs (e.g. Prompt, ALS, aPLS, Triage)
• Register your interest in a QPSP-facilitated education session or workshop or liaise with our statewide Sepsis Clinical Nurse Consultant for advice or support with initiatives and presentations.