Do we really need to give those fluids?

Do we really need to give those fluids you ordered?
A very smart nurse was directed to ask me this question as a trigger from nursing leadership/pharmacy to conserve IV fluids in light of the shortage and our limited supply.
The patient was a teenager with a headache.  We decided to hold off on the fluids– he did fine.
With the increasing technology in health care it is hard to believe the growing number of medication shortages occurring each year in pediatrics- and now one of our most effective life saving medicines- SALINE is on that list.
I began to worry when I was asked this question for a 6-month old who “looked well” with vomiting, fever, and P=170s
Are you having these discussions at your institution?
The fluid shortage will create greater challenges in effectively treating septic shock.
Adherence with septic shock guidelines SAVES LIVES-  Adherence with American College of Critical Care Medicine guidelines (reduced mortality from 38 to 8%)
Improving Adherence to PALS Septic Shock Guidelines (Paul et al)  was published online in Pediatrics this week.
Fluids have been identified as the major barrier to guideline adherence in studies at major US children’s hospitals:   CruzTexas,  LarsenUtah, PaulBoston
This study noted that use of an IV fluid pump was a major contributor to poor adherence.
Through repeated PDSA cycles they achieved 100% adherence with 60cc/kg in the first hour after their intervention!  Click here to read more.
Follow the old mantra-FLUIDS/FLUIDS/FLUIDS 
The team conducted QI interventions with a focus on fluids:
  • every other month education meetings
  • hospital wide online learning
  • a skills day for nursing staff
  • EMR/order set led to a lightning bolt on the tracking board to ID the patient
  • a large clock placed in the resuscitation area— started for all possible septic patients
pushpull

Push-Pull Method for IV Fluid Bolus from Brad Sobolewski on Vimeo.

ACCMguidlines

ACCM guidelines: 60cc/kg in the first 15 minutes!

Have you started a pediatric septic shock QI protocol at your institution?
–  leading cause of morbidity and mortality in our Pediatric EDs (40,000 US cases per year)
–  Mortality in the US is as high as 10-29% (higher if co-morbid conditions)
–  Cost per admission $41,000
Interested in getting involved in national pediatric sepsis quality improvement efforts?
Marc Auerbach

Marc Auerbach

Associate Professor, Director of Pedatric Simulation at Yale University School of Medicine
Marc is co-chair of the Pediatric Academic Society’s Special Interest Group on Simulation-Based Research and co-chair of INSPIRE (International Network for Pediatric Simulation-Based Pediatric Innovation, Research, and Education). A self-proclaimed “super geek,” Marc’s research and educational activities leverage technology to improve patient outcomes.
Marc Auerbach
Marc Auerbach

Marc Auerbach

Marc is co-chair of the Pediatric Academic Society’s Special Interest Group on Simulation-Based Research and co-chair of INSPIRE (International Network for Pediatric Simulation-Based Pediatric Innovation, Research, and Education). A self-proclaimed “super geek,” Marc’s research and educational activities leverage technology to improve patient outcomes.