153 Implementation of a sepsis care pathway and adherence to time-specific milestones in obstetric patients

Abstract

Sepsis is a leading cause of maternal mortality, accounting for >10% of maternal deaths. The best predictors of improved outcomes are early recognition of sepsis and intervention with fluid resuscitation, antibiotics, and source control (or Early Goal Directed Therapy – EGDT). Our hospital implemented an EGDT care pathway (Code Sepsis) involving a rapid response team in 10/2016, and order sets were created to guide providers through the recommended goals at prespecified timepoints (Table 1). The aim of this study was to describe our hospital’s experience with the sepsis care pathway and adherence to time-specific milestones in our obstetric population. Obstetric patients who had a Code Sepsis initiated within the EMR from 10/2016-12/2018 were automatically reported to the hospital’s sepsis coordinator. The records of these patients were reviewed to evaluate if and when each component of the sepsis order set was performed. The proportion of patients who had each milestone completed was calculated, as well as whether the milestones were completed in the recommended timeframe. There were 126 Code Sepsis events. Overall compliance with the recommended steps was high – 94% of women had a lactic acid obtained and 92% had initiation of antibiotics and IV fluid administration as recommended (Table 2). Only 67% had blood cultures obtained; however, this was at the discretion of the physician in obvious cases of infection such as chorioamnionitis. For the six-hour bundle elements, 88% had documentation of reassessment of fluid status, and 82% had a repeat lactic acid obtained. Only 5% had vasopressors given. Overall, the majority of the interventions were performed in the recommend 3- or 6-hour timeframes (Table 2). There was high compliance (>80%) on our obstetric service associated with completion of steps in a sepsis care pathway for the evaluation and treatment of sepsis – with >75% completed within the recommended time frame. A sepsis coordinator provided timely feedback to the managing team. The impact of this protocol on maternal outcomes warrants further evaluation.View Large Image Figure ViewerDownload Hi-res image Download (PPT)