Deterioration -

Sepsis

Alana Hunt
25th March 2019

@MatNeoQI
improvement.nhs.uk
“To reduce the proportion of term babies’
Main title for slide set
admitted to the neonatal unit with Optional
suspected sub title or
sepsis by 25% by 31st March 2019.”name
Welco
me
Scope –
babies born @ 37 weeks gestation and above.

@MatNeoQI
 Background
• All mothers were receiving same antibiotics Main title for
in labour whenslide set
they
became pyrexial. Optional sub title or
• name
All babies of these mothers were being treated with intravenous
antibiotics.
• 3 month period – 57 babies treated with antibiotics, none of which
had positive blood cultures.
• 2 debriefs/ month re separation when baby receiving antibiotics.
• Lack of guidance and therefore lack of appropriate antibiotic
prophylaxis in labour.

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Anticipated benefits to patients and staff
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• Reduced workload Welco Optional sub title or
• Reduction on unnecessary harmname
and
me
separation of mothers and babies
• Reduced hospital stay
• Increased patient and staff satisfaction

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 Co-brand logo here
Driver Diagrams
AIM PRIMARY DRIVERS SECONDARY DRIVERS

Welco
me

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Improvement Approach
• Diagnostic, background and team establishment
• Culture survey and debriefing sessions
• Process mapping and planning
• Model for improvement – PDSA cycles
• Data analysis and testing reliable implementation
• Communication, communication, communication,
communication, communication!

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 Measurement
Outcome Measure: Number of term babies admitted to the neonatal
Main unittitle
with suspected
for slidesepsis
set
Process Measures:
•
Welco Optional sub title or
Number of term babies being treated with intravenous antibiotics with risk factors for sepsis in
name
transitional care
me
• Proportion of eligible women receiving intravenous antibiotic prophylaxis in labour
• Proportion of women who receive antibiotic treatment in the peripartum period due to pyrexia or
sepsis
• Proportion of mothers and babies being separated due to the baby receiving intravenous antibiotics
• Proportion of processes or pathways reliably implemented
• Proportion of staff undertaking the culture survey
• Proportion of improvement projects that women are deeply involved with
• Number of excellence incidents/number of learning activities post incident
Balancing Measure: Number of positive blood cultures for all term babies who have been screened.

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Measuring for success –
who, when, where, how? No. of excellence
6 activities
4
2 No of QI projects
0 women are involved
Then Now (6 months
later)

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PDSA Testing Ramp for
Pyrexia Prevention Stickers
1E: DW 60 staff within MDT – positive
Main title for slide set
feedback
Optional sub title or
Welco
AP
Cycle 1D: PPS – DW MDT and practical issue
name
identified, no air con on ward, removed 24 hrs
SD from criteria

me Cycle 1C: PPS – Tested on 10 women, positive feedback

anecdotally, 2 required antibiotics.

AP Cycle 1B: PPS – Tested on 2 further women, midwives feedback re wording

SD unclear on 4th instruction.
Cycle 1A: Pyrexia prevention stickers (PPS) – tested on 3 women, no ABX required. 24
hrs postnatal added to criteria.

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 August – October 2018
PDSA
ramp 2
Joint Guideline for Comm’s
the Management of
Peripartum Pyrexia
and Sepsis PDSA ramp
1
Stickers
For any maternal temperature >37.2˚C in labour or immediately
postnatal:
□ Turn air con on/reduce room temp to at least 19˚C
□ Place cold flannels on woman’s forehead/wrists/ankles
□ Increase oral/ IV fluids where appropriate
□ Repeat temp in 1 hour; if still >37.2 repeat sticker, if > 37.5 follow
flow chart

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Number of term babies admitted to the neonatal unit with
suspected sepsis

NND
↑ Maternal pyrexia

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Number of babies being treated with intravenous antibiotics
with risk factors for sepsis in transitional care.

Antibiotic prophylaxis – GBS and preterm labour guidance

Guideline for 'Management of Peripartum Pyrexia and Sepsis'

Commenced PDSA ramp 1 testing

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Mother and baby separation due to
babies’ requiring intravenous
antibiotics
April-June: 57 babies treated
↓ ↓
Sept-Nov: 39 babies treated
Dec-Feb: 32 babies treated

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Outcome / learning
• Reduced variation and reduction in the
Welco Mainnumber
title for slide
of set
Optional sub title or
babies receiving antibiotic treatmentname
in transitional care.
me
• No change in number of babies being admitted to the
neonatal unit with suspected sepsis.
• Reliability and staff awareness improving regarding use
of new processes, pathways and tools.
• Ongoing PDSA’s, testing reliable implementation,
communication and raising awareness.
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 Key Messages
Barriers and challenges: Main title for slide set
• Welco
EPMA reports, EHR, building a QI team when short staffed
Optional sub titleand
or low
morale name
• me
Culture and communication

What’s going well?

• Increased awareness of the culture within our unit and the things
that effect this
• Increased awareness and staff engagement around QI
methodologies and change ideas
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Key Recommendations – What was
really helpful?!
Working clinically – take every opportunity
to talk to everybody, ALOT.

Team support

Admin
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Next Steps…
• PDSA 3 – risk assessment tool – continue testing
• PDSA 4 – RAG rating baby hats/blankets
• PDSA 5 – sepsis trolley
• Continue to monitor data and test all changes reliably
implemented
• Continue to communicate QI progress regularly with
staff; 5 times, 5 ways.
• Continue sharing excellence and learning through LLS
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Next Steps…
CELEBRATE OUR SUCCESSES wherever andset
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Welco
whenever possible!! Presentations, walk
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name
me
rounds, awareness days, talk until you can’t
anymore and hi-jack as many meetings as
you can get away with 

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Celebrating a fantastic year of QI!!

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@MatNeoQI
Thank you!

Questions?

@MatNeoQI