Presenter Status
Fellow
Abstract Type
QI
Primary Mentor
Leslie Hueschen
Start Date
12-5-2025 11:30 AM
End Date
12-5-2025 1:30 PM
Presentation Type
Poster Presentation
Description
Background
National data supports balanced fluid during volume resuscitation in the setting of sepsis as it improves morbidity and mortality, particularly preventing acidosis and kidney injury. Despite this recommendation, the CMH ED still has not implemented balanced fluid resuscitation.
Aim
The aim of the project is to increase the percentage of patients with positive sepsis screen treated in the CMH Adele Hall Emergency Department receiving lactated ringer’s fluid resuscitation from 4.6% to 15% by June 2024.
Methods
Primary outcome measures were percentage of patients with suspected sepsis who received at least one LR fluid bolus, as well as percentage of patients who received LR as their first fluid bolus. Primary process measure was sepsis huddle form usage. Primary balance measure was the number of LR fluid boluses ordered in the ED for any indication. Fishbone diagram was utilized to identify interventions. PDSA 1 included division education, updating the sepsis care process model, updating the sepsis order set for LR to be the default fluid ordered, and difficult IV access pathway being published. PDSA 2 focused on readily stocking LR in the medication room, surveying physicians about LR usage, and adding a note to the huddle form recommending LR. PDSA 3 included float pool education and the sepsis care process model including ceftriaxone and LR incompatibility. PDSA 4 reeducated nurses on compatibility. PDSA 5 linked the sepsis order set to the huddle form. An FMEA was completed between PDSA 2&3 to help safely implement LR given its ceftriaxone incompatibility.
Results
Several centerline shifts noted in June 2023. The percentage of LR utilized as any bolus in sepsis fluid resuscitation in the emergency department demonstrated a center line shift from 4.6% to 33.2%. The percentage of LR used as first bolus in the emergency department showed a centerline shift from 4.6% to 33.27%. Sepsis huddle compliance improved from 45.6% to 51.74%. The number of LR boluses ordered for any indication had a centerline shift from 32.9 to 165.8.
Conclusion
Through multiple interventions, balanced fluid resuscitation was increased in the CMH ED. Order set changes and care process model updates seemed to be the most influential changes. FMEA ensured safe implementation.
Included in
Higher Education and Teaching Commons, Interprofessional Education Commons, Pediatrics Commons
Implementing balanced fluid resuscitation for sepsis patients in a tertiary care pediatric emergency department
Background
National data supports balanced fluid during volume resuscitation in the setting of sepsis as it improves morbidity and mortality, particularly preventing acidosis and kidney injury. Despite this recommendation, the CMH ED still has not implemented balanced fluid resuscitation.
Aim
The aim of the project is to increase the percentage of patients with positive sepsis screen treated in the CMH Adele Hall Emergency Department receiving lactated ringer’s fluid resuscitation from 4.6% to 15% by June 2024.
Methods
Primary outcome measures were percentage of patients with suspected sepsis who received at least one LR fluid bolus, as well as percentage of patients who received LR as their first fluid bolus. Primary process measure was sepsis huddle form usage. Primary balance measure was the number of LR fluid boluses ordered in the ED for any indication. Fishbone diagram was utilized to identify interventions. PDSA 1 included division education, updating the sepsis care process model, updating the sepsis order set for LR to be the default fluid ordered, and difficult IV access pathway being published. PDSA 2 focused on readily stocking LR in the medication room, surveying physicians about LR usage, and adding a note to the huddle form recommending LR. PDSA 3 included float pool education and the sepsis care process model including ceftriaxone and LR incompatibility. PDSA 4 reeducated nurses on compatibility. PDSA 5 linked the sepsis order set to the huddle form. An FMEA was completed between PDSA 2&3 to help safely implement LR given its ceftriaxone incompatibility.
Results
Several centerline shifts noted in June 2023. The percentage of LR utilized as any bolus in sepsis fluid resuscitation in the emergency department demonstrated a center line shift from 4.6% to 33.2%. The percentage of LR used as first bolus in the emergency department showed a centerline shift from 4.6% to 33.27%. Sepsis huddle compliance improved from 45.6% to 51.74%. The number of LR boluses ordered for any indication had a centerline shift from 32.9 to 165.8.
Conclusion
Through multiple interventions, balanced fluid resuscitation was increased in the CMH ED. Order set changes and care process model updates seemed to be the most influential changes. FMEA ensured safe implementation.
