6433 The golden hour for sepsis in a district general hospital – how do we perform and how can our MDT help us improve?

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Objectives Sepsis kills 2.9 million children under five years old globally each year, and five people every hour in the UK.1 2 Early recognition and intervention are crucial, with evidence suggesting a target should be set for administering antibiotics within one hour.3 4 We aimed to review our compliance with this goal and implement improvements through close engagement within our multidisciplinary team (MDT). Methods Case notes were retrospectively reviewed within the paediatric unit of a district general hospital from September 2022 to June 2023. Patients were identified from electronic twice daily MDT handovers. Those with ‘sepsis’ in their diagnosis and those receiving a fluid bolus and intravenous antibiotics were reviewed. Information was obtained from sepsis stickers (a local documentation prompt) and review of clinical notes and drug charts. Results Over the 10-month period, 72 cases were identified. 51 were less than three months old and 5 were immunocompromised. The median age was 2 months, mean 16 months. Sepsis stickers were used in 73% of notes.Time to antibiotics is shown in table 1. Conclusion Analysis We meet the Surviving Sepsis Campaign target of antibiotics within one hour for septic shock in 67% and the more stringent Scottish target of antibiotics within one hour for sepsis in only 41%. The study was limited by the lack of a robust definition for sepsis on the handover documents. It is likely that we have overestimated the number of patients with sepsis and underestimated our performance. However, there is a demonstrated need for local quality improvement in the timely management of sepsis. Intervention The data were presented locally, followed by interviews with medical and nursing staff to understand the practical barriers faced. Processes of prescribing and making up antibiotics were highlighted as challenging. To address the issues raised we have: Developed a sepsis prescribing tool to facilitate timely prescribing Simplified the process of making up common antibiotics Simplified the sepsis sticker Run MDT sessions and simulations to highlight the definition of sepsis specifically and consolidate the changes made We expect these changes will lead to a more stringent use of the diagnosis of sepsis, as well as improved compliance with the golden hour for antibiotic administration. References The UK Sepsis Trust. What is sepsis? [Available from: https://sepsistrust.org/about/about-sepsis/. Rudd KE, Johnson SC, Agesa KM, Shackelford KA, Tsoi D, Kievlan DR, et al. Global, regional, and national sepsis incidence and mortality, 1990-2017: analysis for the Global Burden of Disease Study. Lancet 2020;395(10219):200–11. Weiss SL, Peters MJ, Alhazzani W, Agus MSD, Flori HR, Inwald DP, et al. Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children. Pediatr Crit Care Med 2020;21(2):e52–e106. Scottish Patient Safety Programme HIS. Paediatric Sepsis 6 [Available from: https://ihub.scot/media/9858/paediatric-sepsis-6-web.pdf.

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