SEPSIS IN INFANTS AND CHILDREN- CLINICAL GUIDELINE 1. Aim/Purpose of this Guideline
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1 SEPSIS IN INFANTS AND CHILDREN- CLINICAL GUIDELINE 1. Aim/Purpose of this Guideline 1.1. This guideline is for the management of sepsis in Infants and children. For full guidance please see the Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock: this document is available by searching surviving sepsis campaign and follow the link to guidelines If Infant or child presents with suspected meningococcal sepsis please refer to Algorithms for Management of meningococcal disease and bacterial meningitis in Children and Young people. This document is available by searching meningitis.org and follow link for Health Care Professionals, Hospital Doctorspaediatrics This guideline applies to all staff caring for Infants and Children. It has an impact on children and their families. 2. The Guidance See page 2 Page 1 of 8
2 Page 2 of 8
3 2.1. Sepsis Six Suggested for Audit purposes The Sepsis Six: ALL must be done in 1hr from sepsis recognition Time Sign 1 100% Oxygen High flow oxygen administered 2 IV Fluid IV fluid boluses up to and over 60 mls/kg 3 Cultures Blood cultures sent 4 IV Antibiotics IV antibiotics given as per guideline 5 Bloods Arterial blood gas for lactate, ph and early electrolytes, FBC, U&E, LFTs, Coag & Glucose. Repeat lactate at 1 hr 6 Urine Output Record strict hourly urine output Ensure early senior involvement Page 3 of 8
4 3. Monitoring compliance and effectiveness Element to be Compliance with pathway monitored Achieving all elements of sepsis six recommendations in first hour Lead Audit lead Paediatric consultants Paediatric Anaethetists Tool Sepsis six audit proforma on page 3 Frequency As required, following current 2014 audit outcomes Reporting Child health audit and guidelines meeting arrangements Audit lead Paediatric consultants Acting on recommendations and Lead(s) Change in practice and lessons to be shared Paediatric Anaethetists Child health audit and guidelines meeting Audit lead Paediatric consultants Paediatric Anaethetists Required changes to practice will be identified and actioned within3-6 months. A lead member of the team will be identified to take each change forward where appropriate. Lessons will be shared with all the relevant stakeholders 4. Equality and Diversity 4.1. This document complies with the Royal Cornwall Hospitals NHS Trust service Equality and Diversity statement Equality Impact Assessment The Initial Equality Impact Assessment Screening Form is at Appendix 2. Page 4 of 8
5 Appendix 1. Governance Information Document Title Clinical Guideline for the management of sepsis in infants and children. Date Issued/Approved: July 2014 Date Valid From: July 2014 Date Valid To: July 2014 Directorate / Department responsible (author/owner): Contact details: Dr.M.Thorpe Paediatric consultant Dr.J.Berry Consultant in anaesthesia and intensive care Dr.T.Fontane original format T.Fergus- formatting Brief summary of contents Clinical Guideline for the management of sepsis in infants and children. Includes clear pathway of care. Suggested Keywords: Target Audience Executive Director responsible for Policy: Date revised: July 2014 This document replaces (exact title of previous version): Approval route (names of committees)/consultation: Divisional Manager confirming approval processes Name and Post Title of additional signatories Signature of Executive Director giving approval Page 5 of 8 Sepsis Paediatric Shock Infection Child RCHT PCH CFT KCCG New Document Paediatric consultants Anaesthetics- Dr.J.Berry Paediatric pharmacist Medical professional weekly meeting Child health audit and guidelines Divisional board meeting Sheena Wallace Not Required {Original Copy Signed}
6 Publication Location (refer to Policy on Policies Approvals and Ratification): Document Library Folder/Sub Folder Links to key external standards Related Documents: Training Need Identified? Internet & Intranet Paediatrics Intranet Only Surviving sepsis Sepsis six Implementation will be disseminated across directorate. Version Control Table Date Versio n No Summary of Changes Changes Made by (Name and Job Title) July 2014 V1.0 Initial Issue Dr.M.Thorpe paediatric consultant Dr. J. Berry consultant anaesthetist T.Fergus- format only All or part of this document can be released under the Freedom of Information Act 2000 This document is to be retained for 10 years from the date of expiry. This document is only valid on the day of printing Controlled Document This document has been created following the Royal Cornwall Hospitals NHS Trust Policy on Document Production. It should not be altered in any way without the express permission of the author or their Line Manager. Page 6 of 8
7 Appendix 2. Initial Equality Impact Assessment Form Name of the strategy / policy /proposal / service function to be assessed (hereafter referred to as policy) (Provide brief description): Clinical Guideline for the management of sepsis in infants and children. Directorate and service area: Child Health Name of individual completing assessment: T.Fergus 1. Policy Aim* Who is the strategy / policy / proposal / service function aimed at? Is this a new or existing Policy? new Telephone: Clear guidance for the first hour of treatment in infants and children with sepsis. 2. Policy Objectives* Clear guidance for the first hour of treatment in infants and children with sepsis. 3. Policy intended Outcomes* 4. *How will you measure the outcome? 5. Who is intended to benefit from the policy? 6a) Is consultation required with the workforce, equality groups, local interest groups etc. around this policy? Evidence based standardised practice. Audit Children and families. no b) If yes, have these *groups been consulted? C). Please list any groups who have been consulted about this procedure. 7. The Impact Please complete the following table. Are there concerns that the policy could have differential impact on: Equality Strands: Yes No Rationale for Assessment / Existing Evidence Age Page 7 of 8
8 Sex (male, female, transgender / gender reassignment) Race / Ethnic communities /groups Disability - learning disability, physical disability, sensory impairment and mental health problems Religion / other beliefs Marriage and civil partnership Pregnancy and maternity Sexual Orientation, x Bisexual, Gay, heterosexual, Lesbian You will need to continue to a full Equality Impact Assessment if the following have been highlighted: You have ticked Yes in any column above and No consultation or evidence of there being consultation- this excludes any policies which have been identified as not requiring consultation. or Major service redesign or development 8. Please indicate if a full equality analysis is recommended. Yes No x 9. If you are not recommending a Full Impact assessment please explain why. No areas indicated Signature of policy developer / lead manager / director T.Fergus Date of completion and submission July 2014 Names and signatures of members carrying out the Screening Assessment Keep one copy and send a copy to the Human Rights, Equality and Inclusion Lead, c/o Royal Cornwall Hospitals NHS Trust, Human Resources Department, Knowledge Spa, Truro, Cornwall, TR1 3HD A summary of the results will be published on the Trust s web site. Signed T.Fergus Date July 2014 Page 8 of 8
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