Who needs to take action?
This is a safety critical HSE National Patient Safety Alert (NPSA). This alert is for action by Regional Executive Officers, Hospital Group and Hospital CEOs, Directors/General Managers/ Leads of Quality and Patient Safety, all relevant clinical staff and managers with responsibility for Emergency Departments and all areas for unscheduled Paediatric care and Chairs of Deteriorating Patient Committees / Sepsis Committees.
What is the safety issue?
Sepsis/Septic shock can cause significant morbidity and mortality in paediatric and young adult patients. Early recognition and treatment are vital to improving patient outcomes. Recent reviews of children and young people presenting with sepsis have highlighted the challenges of recognising and responding to sepsis in busy and overcrowded emergency settings.
How to take action?
1. Bring this alert and the associated patient safety supplement to the attention of all clinical staff working in the Emergency Department (ED) and its environs and all areas for unscheduled Paediatric care.
2. Share and discuss the insights below from recent reviews with all staff who care for children and young adults in your ED and units for unscheduled paediatric care; e.g. as part of huddles, team meetings and induction for any agency, locum or new staff.
3. Have sepsis forms visible and readily available for use, including in triage rooms, and ensure staff are aware of their location (Appendix A).
4. Use the HSE sepsis specific information (videos for waiting room, patient leaflets etc.) and training materials available via HSEland ‘Recognition and Management of Sepsis in Children’.
5. Ensure staff are up to date on mandatory clinical training – ICTS, Sepsis, Paediatric Early Warning System (PEWS).
Learning Insights from Sepsis Reviews
- Think sepsis if a child or young person has signs and symptoms e.g. limb pain, or tachycardia that is not explained by injury, fever /or crying, particularly if they are not improving while on treatment already prescribed for the same complaint.
- During all assessments, listen to the parent/carer in determining what is normal for their child and what may have changed.
- Remember that risk factors can increase the vulnerability of a child or young person developing sepsis e.g. an infant less than 3 months of age or intellectual disability, note risk factors on Sepsis form (Appendix A).
- Be aware that sepsis should be considered in children and young people with viral illness who are returning for assessment (from General Practitioner or Emergency Department) and who are not improving.
- Every time you interact with the child or young person reconsider if Red/Amber flags or risk factors present? (Sepsis form Appendix A).
- Suspected sepsis must be escalated for review using ISBAR in line with the Sepsis Protocols.
- At discharge, children and young people with a suspected or diagnosed infection, should have normal vital signs recorded (unless reviewed with a Consultant who agrees with the care plan) and the parents should be given specific sepsis safety advice.
- The Paediatric Sepsis Form can be initiated by either a nurse or doctor at any time during the episode of care in the ED or setting of unscheduled care.
- Sepsis is a time critical medical emergency. Follow the Sepsis 6 protocol and escalate without delay.
When does action need to be completed?
Actions 1 - 4 should be completed in 48 hrs (22nd December, 2023)
Action 5 requires ongoing attention
Download the alert as a PDF
Download the HSE NPSA Local Action Plan