Skip to main content

Advertising Disclaimer »

Main menu

  • Journals
    • Pediatrics
    • Hospital Pediatrics
    • Pediatrics in Review
    • NeoReviews
    • AAP Grand Rounds
    • AAP News
  • Authors/Reviewers
    • Submit Manuscript
    • Author Guidelines
    • Reviewer Guidelines
    • Open Access
    • Editorial Policies
  • Content
    • Current Issue
    • Online First
    • Archive
    • Blogs
    • Topic/Program Collections
    • AAP Meeting Abstracts
  • Pediatric Collections
    • COVID-19
    • Racism and Its Effects on Pediatric Health
    • More Collections...
  • AAP Policy
  • Supplements
    • Supplements
    • Publish Supplement
  • Multimedia
    • Video Abstracts
    • Pediatrics On Call Podcast
  • Subscribe
  • Alerts
  • Careers
  • Other Publications
    • American Academy of Pediatrics

User menu

  • Log in
  • My Cart

Search

  • Advanced search
American Academy of Pediatrics

AAP Gateway

Advanced Search

AAP Logo

  • Log in
  • My Cart
  • Journals
    • Pediatrics
    • Hospital Pediatrics
    • Pediatrics in Review
    • NeoReviews
    • AAP Grand Rounds
    • AAP News
  • Authors/Reviewers
    • Submit Manuscript
    • Author Guidelines
    • Reviewer Guidelines
    • Open Access
    • Editorial Policies
  • Content
    • Current Issue
    • Online First
    • Archive
    • Blogs
    • Topic/Program Collections
    • AAP Meeting Abstracts
  • Pediatric Collections
    • COVID-19
    • Racism and Its Effects on Pediatric Health
    • More Collections...
  • AAP Policy
  • Supplements
    • Supplements
    • Publish Supplement
  • Multimedia
    • Video Abstracts
    • Pediatrics On Call Podcast
  • Subscribe
  • Alerts
  • Careers

Discover Pediatric Collections on COVID-19 and Racism and Its Effects on Pediatric Health

American Academy of Pediatrics
Quality Report

Improving Adherence to PALS Septic Shock Guidelines

Raina Paul, Elliot Melendez, Anne Stack, Andrew Capraro, Michael Monuteaux and Mark I. Neuman
Pediatrics May 2014, 133 (5) e1358-e1366; DOI: https://doi.org/10.1542/peds.2013-3871
Raina Paul
aDepartment of Emergency Medicine, Pediatric Section, Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina; and
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Elliot Melendez
bDivision of Emergency Medicine, and
cMedicine Critical Care Program, Boston Children's Hospital, Boston, Massachusetts
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Anne Stack
bDivision of Emergency Medicine, and
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Andrew Capraro
bDivision of Emergency Medicine, and
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Michael Monuteaux
bDivision of Emergency Medicine, and
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Mark I. Neuman
bDivision of Emergency Medicine, and
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • Info & Metrics
  • Comments
Loading

This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.

Download PDF

Abstract

BACKGROUND AND OBJECTIVES: Few studies have demonstrated improvement in adherence to Pediatric Advanced Life Support guidelines for severe sepsis and septic shock. We sought to improve adherence to national guidelines for children with septic shock in a pediatric emergency department with poor guideline adherence.

METHODS: Prospective cohort study of children presenting to a tertiary care pediatric emergency department with septic shock. Quality improvement (QI) interventions, including repeated plan-do-study-act cycles, were used to improve adherence to a 5-component sepsis bundle, including timely (1) recognition of septic shock, (2) vascular access, (3) administration of intravenous (IV) fluid, (4) antibiotics, and (5) vasoactive agents. The intervention focused on IV fluid delivery as a key driver impacting bundle adherence, and adherence was measured using statistical process control methodology.

RESULTS: Two-hundred forty-two patients were included: 126 subjects before the intervention (November 2009 to March 2011), and 116 patients during the QI intervention (October 2011 to May 2013). We achieved 100% adherence for all metrics, including (1) administration of 60 mL/kg IV fluid within 60 minutes (increased from baseline adherence rate of 37%), (2) administration of vasoactive agents within 60 minutes (baseline rate of 35%), and (3) 5-component bundle adherence (baseline rate of 19%). Improvement was sustained over 9 months. The number of septic shock cases between each death from this condition increased after implementation of the QI intervention.

CONCLUSIONS: Using QI methodology, we have demonstrated improved adherence to national guidelines for severe sepsis and septic shock.

  • sepsis
  • severe sepsis
  • septic shock
  • PALS
  • quality improvement
  • adherence
  • guidelines
  • Accepted January 22, 2014.
  • Copyright © 2014 by the American Academy of Pediatrics

Individual Login

Log in
You will be redirected to aap.org to login or to create your account.

Institutional Login

via Institution

You may be able to gain access using your login credentials for your institution. Contact your librarian or administrator if you do not have a username and password.

Log in through your institution

If your organization uses OpenAthens, you can log in using your OpenAthens username and password. To check if your institution is supported, please see this list. Contact your library for more details.

Purchase access

You may purchase access to this article. This will require you to create an account if you don't already have one.

Offer Reprints

PreviousNext
Back to top

Advertising Disclaimer »

In this issue

Pediatrics
Vol. 133, Issue 5
1 May 2014
  • Table of Contents
  • Index by author
View this article with LENS
PreviousNext
Email Article

Thank you for your interest in spreading the word on American Academy of Pediatrics.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Improving Adherence to PALS Septic Shock Guidelines
(Your Name) has sent you a message from American Academy of Pediatrics
(Your Name) thought you would like to see the American Academy of Pediatrics web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Request Permissions
Article Alerts
Log in
You will be redirected to aap.org to login or to create your account.
Or Sign In to Email Alerts with your Email Address
Citation Tools
Improving Adherence to PALS Septic Shock Guidelines
Raina Paul, Elliot Melendez, Anne Stack, Andrew Capraro, Michael Monuteaux, Mark I. Neuman
Pediatrics May 2014, 133 (5) e1358-e1366; DOI: 10.1542/peds.2013-3871

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Share
Improving Adherence to PALS Septic Shock Guidelines
Raina Paul, Elliot Melendez, Anne Stack, Andrew Capraro, Michael Monuteaux, Mark I. Neuman
Pediatrics May 2014, 133 (5) e1358-e1366; DOI: 10.1542/peds.2013-3871
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
Print
Download PDF
Insight Alerts
  • Table of Contents

Jump to section

  • Article
    • Abstract
    • Methods
    • Results
    • Discussion
    • Conclusions
    • Acknowledgments
    • Footnotes
    • References
  • Figures & Data
  • Info & Metrics
  • Comments

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • How to close the maternal and neonatal sepsis gap in sub-Saharan Africa
  • Improvement science is a partner in basic and clinical research
  • Diversity in the emergency care for febrile children in Europe: a questionnaire study
  • Bundling Interventions to Enhance Pain Care Quality (BITE Pain) in Medical Surgical Patients
  • Paediatric sepsis, the under-recognised killer: quality improvement initiative of outreach teaching in paediatric sepsis
  • Reducing Hospitalization Rates for Children With Anaphylaxis
  • Modification of an Established Pediatric Asthma Pathway Improves Evidence-Based, Efficient Care
  • High Reliability Pediatric Septic Shock Quality Improvement Initiative and Decreasing Mortality
  • A prospective quality improvement study in the emergency department targeting paediatric sepsis
  • Implementation of an Inpatient Pediatric Sepsis Identification Pathway
  • The development and evaluation of an evidence-based guideline programme to improve care in a paediatric emergency department
  • Sepsis in children
  • Google Scholar

More in this TOC Section

  • Increasing Volume-Targeted Ventilation Use in the NICU
  • Improving Inpatient Consult Communication Through a Standardized Tool
  • Diagnostic Stewardship of Endotracheal Aspirate Cultures in a PICU
Show more Quality Report

Similar Articles

Subjects

  • Emergency Medicine
    • Emergency Medicine
    • Trauma
  • Administration/Practice Management
    • Quality Improvement
    • Administration/Practice Management

Keywords

  • sepsis
  • severe sepsis
  • septic shock
  • PALS
  • quality improvement
  • adherence
  • guidelines
  • Journal Info
  • Editorial Board
  • Editorial Policies
  • Overview
  • Licensing Information
  • Authors/Reviewers
  • Author Guidelines
  • Submit My Manuscript
  • Open Access
  • Reviewer Guidelines
  • Librarians
  • Institutional Subscriptions
  • Usage Stats
  • Support
  • Contact Us
  • Subscribe
  • Resources
  • Media Kit
  • About
  • International Access
  • Terms of Use
  • Privacy Statement
  • FAQ
  • AAP.org
  • shopAAP
  • Follow American Academy of Pediatrics on Instagram
  • Visit American Academy of Pediatrics on Facebook
  • Follow American Academy of Pediatrics on Twitter
  • Follow American Academy of Pediatrics on Youtube
  • RSS
American Academy of Pediatrics

© 2021 American Academy of Pediatrics