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G291(P) The neonatal sepsis trolley: A quality improvement project
  1. E Collinson,
  2. L Watson,
  3. J Ross
  1. Paediatric Emergency Department, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK


Aims In stable, febrile neonates, and many infants<3 months old, NICE recommends completing a full septic screen (including lumbar puncture) before antibiotics. This should only occur if it does not delay antibiotic administration and antibiotics are administered within 1 hour. Following a serious incident we recognised that we were not meeting this target and wanted to find a solution.

The solution was the introduction of a sepsis trolley to the Paediatric Emergency Department (PED). The trolley contains equipment required for:

Intravenous access

Lumbar puncture

Urine collection

Fluid boluses

In addition it includes an aide memoire for laboratory investigations and a comprehensive 1 page antibiotic prescribing and administration guide.

Education was key and the trolley was launched at medical and nursing study days and incorporated into PED teaching.

This study aims to assess the trolley’s impact in infants<3 months old.

Method Baseline performance was determined by reviewing the notes of all infants<3 months old who underwent a full septic screen in PED in the 6 months preceding the trolley’s introduction. 2 months after the introduction of the trolley the audit was repeated and a structured, qualitative questionnaire was circulated to medical and nursing staff.

Results The baseline audit showed an average time of 166 min from registration to antibiotics, or 153 min from triage to antibiotics. Of these infants 91% were at high risk of sepsis (NICE 2016). After introduction of the trolley, this time has been cut to 105 min from registration to antibiotics, and 81 min from triage to antibiotics. Qualitative feedback was obtained from 10 members of staff. This feedback was consistently positive with frequent acclaim for the antibiotic guide.

Conclusion Introducing a sepsis trolley has reduced time to antibiotics by over 60 min, a clinically significant improvement, but still falling short of the 60 min target. The benefit of the trolley has gone beyond the equipment it contains It acts as a visual reminder within PED and has raised the profile of sepsis and it’s management. The challenge is to build on this momentum and further improve the process.

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