Paediatric Sepsis Series — Implementation Toolkit

Transcript

All right, we might get started. It's two o'clock and welcome

everybody to our fourth installment.

I believe of the Pediatric sepsis seminar

series October's topic

is all around the pathway toolkit. So

that's what I'm going to be presenting on today. I've got

a bit of the makeshift set up at the moment. I'm usually working

from home on two screens, but today's just one. So please speak up

if I lose slides or lose sound. Let

me know. I'm Jada here on the principal project

officer of the Queensland pediatric sepsis program and

just a reminder to keep yourself on mute

and property questions in the chat.

We've also got Sarah Somerville online our wonderful

project admin. And so Sarah will moderate any of your questions

or any of issues with sound and stuff as well. So, please please use

the chat and reach out to Sarah.

So just like to start off by acknowledging the traditional

custodians of the land which we meet and pay

our respects to past Elders past present and

emerging. And today we meet on I'm based

in Brisbane or me engine and the Jagger enterable

people are traditional owners here. And I'd also

like to pay my respects to Sherry skiel who's designed

this lovely artwork at the base of

all of our slides that you'll see today and cherries are

proud bajaro woman from South West Queensland, and the

title of this of this

artwork is called healing Journey.

So just a little bit of an overview. I

think we have 45 minutes for today's session and I'll

just spend a little bit of time at the start just setting

the scene a little I know we have some people

online who have attended previous sessions. So there

will be a little bit of a repeat content but

it's important to obviously set the context in terms of sepsis

being a global priority will also

then touch on who we are

the Queensland pediatric sepsis program team and what our program

goals are and how the toolkit that I'm going to present on today

fits within those goals of the program.

And obviously in response to sepsis being

a global Health priority and effective in such a significant

number of families and children are provide a

little bit of the Australian context as well and mostly in

terms of the recently released sepsis clinical

Care standard from the Australian Commission of health

and safety. I think it was released in June this year and as

part of that standard we'll discuss obviously one of

the indicators which is a locally approved pathway,

which we have developed here in Queensland. So I'll touch briefly on

the pathway.

And then we will launch into

the toolkit. So what you're all here for I'll discuss the toolkit and

how we designed it the development

process in terms of that and the co-design process

without inpatient sites talk you through the framework for

the resources that make up the toolkit and then obviously give you a little

demo in terms of what the toolkit looks like and what you can

find online.

So just to set the scene as I said before

set to Global Health priority

it was

The latest Global burden of disease report was published

over 50 million cases of sepsis worldwide occur. So

good proportion of those cases occurring children

under five years and then

of those 2.9 Million deaths occur in children

under five.

So sepsis is not just a global Health priority, but it's obviously a

priority here in Australia and in Queensland, Australia each

year. He's 50 children die of sepsis and

while that may not seem like much in terms of that Global context. It's

actually more deaths than road traffic accidents and

Leukemia combined.

Approximately 8% of our picu admissions in

Australia and New Zealand due to sepsis

and one out of four deaths in picu are due

to sepsis as well.

So specifically to the Queensland context back in

patient safety quality improvement service did

a pediatric patient safety review and they

found what they did is a review and Analysis on Step

One cases, which included are critically

clinical incidents that occur

causing obviously death or permanent harm to children and what

they found was eight out of 12 of those stack One cases were actually

due to sepsis and the delayed recognition

and diagnosis of that so we know in Queensland it's

a real burden as well and and affects lots

of families in our system and it's the most common cause of

preventable harm in Queensland here in here in Queensland.

So preventable harming children in Queensland.

so as a result of the

patient safety review and obviously

sepsis being a global burden of

disease the Queensland Health

established the Queensland sepsis program and as part of that and there

was the Breakthrough sepsis collaborative which some of you online

may have been a part of

so what that saw was the development of our adult and pediatric steps as

Pathways and we implemented those around the state

in in a number of different tertiary secondary facilities

and Rural and remote facilities. So out of the collaborative

there was obviously the Queensland

pediatric sepsis program was kind of born out of that and that

had a specific focus on on Pediatrics and

the quality of care and outcomes for children diagnosed

with sepsis to and and our our remix

as a multi disciplinary team is to

reduce the burden of steps that's on families clinicians and their Health

Systems specifically

So with the support of CQ and chq steps has

been has been listed as a priority in the 2022 Queensland

Department of Health operational plan. And we the

QPS P of developed with our stakeholders this five year

roadmap, and I know it's a busy slide, but I just wanted to give you

an idea on where we're trying to go over the next five years.

And what I want to address or just touch on today's is a couple

of these different pillars.

so

I just want to highlight the systems

level the system's level pillar which you would have seen

and alignment with State and National International bodies

and performance monitoring and Reporting. And so

the resources within our toolkit obviously assess

aligned with these standards and

will allow you to monitor how you are going with the Care

standard.

So just to reiterate the sepsis clinical

Care standard, we did do a webinar in July.

I think it was and I believe Sarah will

post the link to previous.

Webinars in the chat today including the

one in July on the sepsis Care standard. There's also

on the Australian commission website. There's there's

lots of resources and a launch video and stuff

on there as well if you haven't seen it.

So just to remind everyone the goal of this this National

Australian sepsis Care standard is to ensure

that a patient presenting with signs and symptoms is recognized early

and that they receive coordinated best practice care.

So the risk of death or ongoing morbidity is reduced.

Within the standard there's a couple of different quality statements

seven quality statements that the

occur across multiple steps of phases from that

early recognition early recognition

and Rapid treatment to planning and discharge and

care for families and patients after after

Hospital.

So I'd just like to draw your attention to Quality statement. Number

two here time critical management and part of

that state part of that those quality statements.

Obviously, there's indicators within each one. That sites will have

to show that they are meeting meeting the Care standard

and one of those is evidence of a locally approved pathway is

as well as access to Diagnostics medicines

and treatments.

Comedy by competency-based training on the pathway as

well as audit of performance including the families experience.

So as part of our toolkit, we've developed

a number of resources to allow you to show that you

are meeting that standard including obviously the pathway which I'll talk

about next but there's also sepsis knowledge

survey and parental leaflet as part of the pathway as

well. So yeah.

So I'm sure a lot

of you online have seen this pathway or probably use it by now.

So but I just wanted to remind everyone what the

Pediatrics is Pathways and what it looks

like and what makes up that pathway. So we talked about the Care

standard and those quality statements and this is that locally approved

pathway that was developed as part of the collaborative as

So all Pathways have a decision support

tool for clinicians that includes a screening on the

first page screening tool to support early recognition of

sepsis and prompt early senior clinical review.

There's then the treatment bundle on page two and the treatment

bundle is to support that timely sepsis treatment in the

first few hours.

There's then the ante anti-microbial guidelines

to support appropriate antibiotic choice

and dose and they are terribly flips.

And then there's the sepsis information leaflet for

families.

So this pathway has been designed by consumers and clinicians

and it's been approved by a number of an endorsed by

number of bodies. And so I just wanted to remind everyone

what that Ed pathway looked like.

So moving into a bit

more of the recent future in 2021. We took

this pathway this if this pathway that

was designed specifically for Ed's around the state and we

needed to look at it and scale it up to inpatients. And so

as part of that in patient Pilot We piloted it

around I think was age different facilities around

Queensland Rural and remote and here in

Brisbane and what we found as

part of that pilot was this call

from clinicians in terms of where they start how do

they Implement? How do they educate in a call for a lot of different

resources? And so this is where the idea of the

toolkit was essentially born?

So as I said, we trialed the inpatient pathway around

the state and the call-out was for a number of different resources.

So obviously awareness of sepsis

is the greatest barrier and so there was a call for posters and

visual aids as I said before lots of

we get lots of requests as part of the pilot that

constantly now in terms of Education what education

resources do we have do we have webinars like this? Do we

have presentations Powerpoints? And so we decided

to build some education

templates that sites could use an adapt

There was also a call out for what the minimum

data set was. How do sites actually collect data? What

should they be collecting on in terms of compliance with the

pathway and their process measures and stuff like that.

And then yeah, I suppose general advice in

terms of how do we embed the pathway? Obviously the

inpatient pathway specifically at this time into business

as usual but this we realize as part of this pilot

that it wasn't just relevant to the inpatient pathway. It's

a constant relaunch awareness of

sepsis and a relaunch of the pathway. So it's relevant. We've built

the toolkit in mind that would be relevant to all areas across

the state and not just within that early implementation

stage.

And so what we did once we realized people

are calling out for these resources. We did a little bit

of research. We thought okay what exists already and what's the

best way to kind of I suppose categorize or

manage all of these resources rather than

just sending out a bunch of emails

and lots of different stuff which is quite overwhelming when you implementing

we found that people wanted it to be broken down into sort of

simpler simplified steps and resources relevant

to that step of implementation.

So we reached out or have a look and

did a bit of research in terms of what existed we have a really

good working partnership with the clinical Excellence Commission in

New South Wales. And there are a few years ahead of us in terms of their pathway and

they're talking and so was very very thankful to

Sarah and Mary.

In those early design stages of our toolkit.

There's obviously the safer care Victoria

one specifically around sepsis, but then there's lots of other toolks

as well implementation resources for other quality improvement

initiatives, including the safer baby bundle and

and Getty.

So once we had all these resources developed it was

it was how do we manage them? How will clinicians access

them? What ones are

useful and so the inpatient sites piloted the

resources, we developed and gave us feedback in terms of what would

be useful what wouldn't in kind of helped us design them. And then

we we conducted a poll to work out. Okay, where do we

store them and over 75% of our impatient

clinicians wanted kind of this step-by-step guide

that I spoke about and so that was similar to

to the Getty toolkit.

so there's obviously a number of ways to

Yeah that we presented. So it was either a PDF

document this online toolkit whether it was a printable printable

resources, but we

didn't realize there's limitations with PDFs in that they

Version Control they go out of date very easy, and

they're very hard to add on to there was the potential

to have a PowerPoint with just all the resources in there. However, it's

very limited in terms of text and

it would just be kind of links. So yeah, so

we developed a step by step guide essentially which is

on the website and we know that we can then add on

as time goes on if people are asking for additional resources.

So as the starting point for categorizing

all of those the resources

that we developed and in terms

of quality improvement and and implementing the

pathway at your sites, we developed

this framework. And so the purpose of this framework was

really to provide facilities guidance,

I suppose so that step

by step approach in terms of how to implement and sustain the pathway

and then what resources were relevant

to each of those steps.

So I just like to talk you through each of those steps just

briefly and then we'll go into a demo of the

toolkit and it will make a little more sense in terms of how the resources

have been categorized.

So step one ID generation. So with

any quality improvement activity you obviously want to figure out

what you're actually trying to establish. And in this instance. It was

obviously implementing the inpatient pathway, but this is relevant to all

quality improvement activities. What changes are you

trying to make and how will that result in Improvement? How will

you know the change has been improved? So there's

that initial idea stage in

terms of what you're trying to do.

The next stage is the planning stage. So

planning for implementation planning

for relaunch planning for raising awareness forceps. So

there's a number

of steps involved within here. So obviously engaging local

stakeholders and local endorsements. So

do you have the support of your of your numbers of your edms

Etc identifying who those

steps as Champions are on the ground? So this is a really

important point and it's not just one person's responsibility.

So identifying multiple steps

as Champions who are going to kind of drive that forward within

each of their areas.

Describing the outcomes to be achieved and planning how

you're going to implement manage and evaluate that you've been successful

in implementing The Path Lane.

There's obviously the importance of collecting Baseline

data. So before inequality Improvement or

before any kind of implementation, we want to have a bit of a benchmark in terms

of how we currently using the pathway. If so, what's our

compliance rate and I'll show

you the data collection tool that we've developed to assist with

that as well. You won't know if you've improved if

you don't collect that initially

Now the next step is responsibilities and practicalities. So

once I set once as I

said before that's those steps is local steps as Champions

who are going to drive this forward really important, but it's not

that one person's responsibility steps this

effects. Obviously a multitude of disciplines, especially with

with our families. We want to involve AMS. We

want to potentially involve social workers our digital

teams. So it's about having kind of that working group

established and working out who's responsible for what in implementing

the pathway

There's also the practicality side and this is something I think we

Overlook because it's it's just assumed but

do you have enough stock

of the pathway? Have you actually ordered the latest version? Do you

have a place where you're going to store it? And does

everybody know all the clinicians know where that where that place is

or where they're going to find it. So preparing the environment for for

launch and for implementation.

The fourth step is education and

launching. So we've developed a multitude of

resources for educating educating

and there's a lot of different modalities as

well. We've got power points and videos as

well as skill stations and stuff, which we've

developed over the last few years. We are very

lucky to have the Statewide clinical nurse consultant Amanda who

has developed a lot of these resources.

And so the idea is that sites can use those resources

and adapt them locally, but at least you have a starting

point.

Is sustaining and this is

something I don't think we do very well. There's always so much

effort and so much passion put into those early four steps

in terms of building building awareness and getting ready for

launch and implementation of the pathway. But then once

we think once we've gone live we've implemented it then then we're

done but we really want

to be able to continuously improve and

continuously measure how we're how we're going with that. And

so there's this piece around sustainability.

um, and yeah, and

then a part of that we've developed Tools in terms of helping you sustain

and embed the pathway into your local business as

usual what kind of courses there are in terms of regular training

making sure you're reporting obviously the

data that you're measuring through the correct channels or

committees and reaching out

for us for additional support if you need to

so without further Ado, let's have a look at the toolkit.

So this is just a little video in terms of where to access

it from. So as I said before we have that poll with our

inpatient sites that they wanted it easily accessible

One-Stop shop that was broken down into those

categories or those steps for implementation. And so

it's on the Children's Health Website. So children's

DOT health dot queensland.gov.au. There's

multiple ways to obviously get here, but this is the way

that I go through.

Search for pathway toolkit.

and then this is the page so

This will just show you that those

steps that we've just talked through in terms of that framework was

was the basis for developing our toolkit and So

within each of those steps, we're accordions on the toolkit

website. We have information relevant

to that step in the resources.

We've also got quick links on the web page as well. So there's

just some quick links there in terms of requesting our support

downloading some other resources that have been developed as part

of that Care standard.

There's also this other way which which others might access the

pathway from or the toolkit from and that's just

the children's sepsis homepage. And this is where all of

our Queensland pediatric sepsis program resources are so targeted

towards health professionals and families. So if

you click on health professionals

And then you'll see pathway toolkit in that left hand margin.

Once again, you get to the same page, but it's just another way of

finding it. I'm sure you can type in pediatric sepsis

or Children's Health Queensland into Google and then

you would be able to navigate that way as well.

So I'm going to launch into actual demo.

hopefully

the size of the screens. Okay, if the text is too small and

you might be able to zoom in on your

screens.

So what I want to show you is just

go through each of these steps and just highlight

one or two of the resources that we've

developed. We won't have time today to go through all of

them. But this is really just about launching the toolkit and letting you know that it's

around and it's now live so you can essentially

after this session go and go and have a play and figure out

what's there?

So within step one that initial idea Generations stage we've got

just a little bit of information in terms of quality improvement the methodologies

and I suppose yeah

different models for improvement kind of if people haven't been

exposed to that before just giving a little bit informant of information in

terms of quality improvement what you're trying to achieve in

answering those questions

There's lots of information within clinical Excellence Queensland

and within chq

as well lots of project management

and type of activity and quality improvement Tools

in there. So what we've tried

to do is have a little bit of text in terms of what that step is

a little bit of guidance and then resources or

links down the bottom of that step.

There's also links to other National and international toolkits that

I spoke about before. So there's the New South

Wales inpatient one. There's a great one from British Columbia.

And so there may be some other resources in

there that are relevant to your site and

that you can adapt as well. So there's just some additional information.

step two planning and preparation

once again a little bit of texts and

then within that step we talk about identifying

your sepsis Champions identifying the

need for the pathway in collecting that initial data establishing

your governance and Reporting lives and engaging

in communicating with stakeholders. So we

we know early on and we know

people want to awareness posters or how do they communicate how

do they identify sepsis Champion? So

this just gives a little bit of information in terms of how you might do that

and then the resources so the one I'd like

to show you I think is in here.

Um, so engaging with your stakeholders or your

clinicians or your colleagues anyone

within your Health Service, whatever's relevant

to your area. We have these sepsis key communication messages.

So if you just click on the link,

so engage the communications expert come up

with some key principles in terms

of communicating the importance

of Pediatric Services and the impact it has on families

and the health system and we had so the

idea of this is is really just to ensure that we're communicating

that consistent message about the

impacts of Pediatrics. So this

Can be used in a multitude of ways, however, you like really

we had as an example. We have a clinician reach

out recently who it was she was a nurse educator

she needed to to come up with some some education

in terms of within her department, and

she just wanted to make sure she was hitting the correct

points in terms of pediatric sepsis. So these were kind of the key

messages that we sent her which was important to kind of highlight to her

staff.

Another example might be if you're raising awareness

or you're having a bit of a leading up

to World sepsis day. You might be

putting something in the bulletin or raising Awareness on WhatsApp. This is

that your at your health facility. And so you can use these to kind

of guide anything with your Communications Department or

do a bulletin or a whole staff email. So these

are those those key key communication messages that

can be used.

um, yeah, so that's

Times and symptoms sepsis treatment so some

once again that consistent messaging in terms of the impact of

sepsis and the pathways.

And so that's the planning

step. And as I said, there's lots of other resources

in there, but due to time. We'll just highlight one from each

one.

Responsibilities and practicalities. So you'll see

me clicking in just as any web page or the

chq if you've used it before these little accordions just expand

and expand and

go down so responsibilities as

I said before it's not just about identifying

those local sepsis Champions. It's really is

And it's a it's a team effort. So

this is just some guidance in terms of who we think could kind

of make up your core team to drive that awareness or to drive that

launch or relaunch of the pathway.

And then who else you may need to consider?

Who makes up that team?

and as part of that we have this responsibilities and

practicalities template and so the idea is that we

You don't need to do all of this. You don't need to use all of these but it's really

just creating something that can be locally adapted

or that would be useful to your sites based on

what the impatient sites or Pilot sites were asking for.

We've tried to keep them as Word documents so you can adapt

them locally and you can edit these and

make them relevant to your local setting.

So, yep. So once again the responsibilities and

then there's the practicalities as

well. So start to consider, you know, the questions and

fill this in so that you know, if you're ready to go and ready to ready to Launch.

and so that's that's

um deliver education and launch. So education

is obviously a key component of

implementing the pathway and continuous

Improvement. So in those

initial in that education point we

have our sepsis education web page

if you click on that and as

I mentioned with with developed these education resources over

the last few years and we're just keep adding on so there's

a lot there and we've tried to break it down based on

kind of the format. We've got courses and webinars and

we now have pediatric steps as case studies within all of

the Optimus Prime and bonus courses

and there's also some simulation. I think it's Optimus

Prime I think is no sorry Optimus bonus

is the same package which is

a specifically around set so

you can do that.

There's obviously we're partnered

with the Australian sepsis Network. I think they're now called sepsis Australia

and they actually have a massive library

of lectures that you can watch and

get CBD CPD points for so any

specific pediatric success ones that

we the QPS or Amanda has delivered on will be

LinkedIn here.

We've also got some education specifically around the pathway.

This is our how to

use the Pediatric Services Pathways is kind of the first point of

call that we encourage people new

to using the pathway junior junior nurses or any junior staff

who haven't seen it before and that's really

just a 10-minute grab 10 minute really quick video in terms

of introducing Pediatric Services and how to use the pathway. So that's

a really good resource. There's posters if you

remember that to that slide in terms of what in patient sites we're

asking for with all those speech bubbles awareness is the

greatest barrier. So we've tried to create lots of posters that

can be hung around in tea rooms obviously clinician

facing and family facing

but there's yet there's some posters and stuff on here

that can be downloaded and printed as well and hung around the place.

There's also skill stations how

which are relevant

to the pathway in that treatment bundle in terms of how to prepare adrenaline infusions

how to take blood cultures and

these are great little two to 10

minute videos. So once again really using them and adapting

them how you like whether you just show

your stuff that they're there whether you do wash them together do it an

in-service do it in the Huddle because of their varying lengths,

they're a good point to refer to as

well.

and

there's the case studies. So these here

the Pediatric sectors pathway education with

case studies. This is something that people have

used a lot we get constant emails in

Pediatrics account. I'm not sure if I said this before but asking

do we have any education materials that they

can use to adapt locally? And so there's a number

of different PowerPoints on here. So you're

not starting with the blank canvas. You can really use this

use these tools. Use these PowerPoints is a bit of a starting point

and then adding either use the case studies that we have

on there or add in any specific local case studies if that's more relevant

to you. And so there's a number of different PowerPoints on

there rural of remote specific and then

some other stuff as well in terms of the treatment bundle and

talking through that.

So back to education.

That's all actually how we're going good time 2:30. Yep,

step 5 ongoing awareness and sustainability

as I mentioned before there's

it's really important to kind of

not lose all that hard work that's been done

in terms of relaunching or implementing the pathway. So sustainability just

means

You know constantly evolving or constantly measuring and making

sure that you are you are improving.

And that you're not going to lose all that hard work that you've done.

So the NHS has a really great sustainability

guide and has some really practical Tools

in there to to help with sustainability.

And so that's been LinkedIn. There's then obviously

embedding into standardized processes conducting regular

training measuring and evaluating and

how you report the progress and share those learnings amongst your

teams and So within each of those steps, there's some

resources, but I just like to show you the data

collection tool.

Which is here.

And so the data collection tool as well.

Will data collection essentially will make us

we'll make sites. I suppose show the

evidence that they are aligning and being accredited against the national

Care standard. And so this this can be

adapted locally, but it has been developed with that in mind.

So many of the process balancing

outcome measures do align with

the national Care standard. So this is a really great starting

point. I know that some sites

have used it in Excel some sorts of taking this as their

template and added it to the Mars system if you

use that so there's the option to to obviously adapt

it to your local processes.

So within the data collection tool there's instructions on use how

to guide

We've listed all of the

ICD-10 sepsis diagnosis code so you can work

with your health information Department there to

obviously to get a report and work out what charts

you might audit. There's the

patient level data capture. So

this is the individual template or performer to

catch information on how to audit those

those records. If you hover over any of

the cells it just highlights what that definition is. So

what you're actually looking for.

There as well.

As I mentioned so the price anything highlighted in

blue aligns with the national

Care standard essentially and what we are what we

are required to measure on.

So that's the patient level and then there's the facility level as well.

So this just gives you

a performer or template in terms of of how

you measuring your pathway utilization your timely anti-biotics your

blood collections. Once again, if you hover over

the top it gives you definition.

and what we suggest is once again that Baseline data

so taking a measurement at some point before you

implement or before you launch and then number of

months after you've launched just to be able to

show that there's been that Improvement and measure measure

against those

the final one

to show you

really simple is

the

Labels, this is just stepping it back enough. So we develop

these labels.

Which can be just printed locally. And

basically it's a conversation starter or you can put some people get

either put it on the child's medical

child or behind the bed. It opens

up that conversation with the

parents. But also with with clinicians as part

of as part of hand over.

So that's it's pretty much additional resources.

Lots of other links in there the implementation

framework, which was that that framework or

guiding guiding steps, which I showed you through and then

links to lots of other posters and stuff as well.

We certainly encourage sites to use this or provide

us feedback. If anything's missing or perhaps

we have a practical tool that you've you've used

or developed locally. We'd be really interested to see

that and if you think it would be relevant or helpful to other sites than

we certainly encourage you that it can be shared we can

we can add it here as well. If you do still require support from

us as the as the qpssp of the Statewide body.

You could register your interest or request support

via this page as well. If you click on register your

interest it will then just ask a number of questions so we

can work out our teams capacity and how we support you.

Um, so back to the slides.

So yeah, so as I said, we piloted a lot

of the resources with those in patient sites, but we wanted to

develop that One Stop Shop where

resources were easy to access but also was an

overwhelming in terms of the content or how many there were so that's

why we've broken it down into steps and and sites

can then adapt to their local use.

I just like to briefly really quickly highlight some

of the other resources that are around so our

website the Pediatric steps this program website.

Which I'm sure you've all seen before there's a number of different. There's

a research tab on there our health professionals Tab

and information for families as well.

As I said part of

the national Care standard, there's been some implementation resources developed

by the Australian Commission on safety and quality. And so

there's lots of great case studies and stuff on there

as well which are interesting reads or interesting resources to share.

And then the sepsis Australia or Australian sepsis network has lots

of other resources for healthcare professionals including that that the

library of lectures all to do with adult in

pediatric sepsis, which you can enroll in for free. They're all

free courses.

And so I've talked a lot about information and

resources for health professionals, but

I just want to highlight as well that the Queensland pediatric

sepsis program has developed a number of

resources for families. We're really really

lucky to have a multi-disciplinary team and we have

a couple of advanced social workers on the

team who are leading Australia and internationally with

our first co-designed peer mentor program Family Support

networks, and we actually in the process of

developing a post-stepsis model of care the we're

also people lucky to have Karen who's

our Aboriginal Torres Strait Islander lead and

Karen's role is developing resources specifically targeting

towards our Aboriginal Torres Strait Islander families

and also connecting with those in community to help raise awareness. So

these are just some of the resources that we've developed specifically targeting

families.

On the Pediatric accepts this family support network.

It's a it's a network for families or

patients who have been diagnosed receptors

as an opportunity for them to connect with other

families as well. So we certainly encourage you to

let families know that this exists

you can have a look on our website. You can download these digitally from

the toolkit page and from our health professionals

page, but you can

also request hard copies as well. So Pediatrics that

Health stock queensland.com.au let

us know what resources you might like and we can get them out in

the post.

We've also developed postcards for with the

signs and symptoms of sepsis and they've been translated into 10 different

languages.

as well

We've also developed a journeying through

steps as video series and this was developed in response to direct

feedback from our families indicating that they wanted consistent

and timely information. So it's an eight-part series

and it's first of its kind and at stages

eight-part series that talks through the stage of

the child's hospital Journey from that initial diagnosis through to intensive

care rehab and support after discharge. So we

encourage you the clinicians online today who

might see these families that you can

direct them to these videos on our website. We encourage

you to use them even just as a starting point for ongoing

discussions.

Clinicians can view them as well and just to increase your knowledge

around sepsis the burden of it on families and

obviously the system. So it's a really

good series certainly encourage everyone to watch that.

So just recappy and that was a bit of a whirlwind in terms

of what the toolkits contains. But

as I said before I encourage you to go go off now that it is

launched and see what's there and certainly provide feedback. There is

a review period so things are missing or if you have any

feedback then certainly let us know but just a key reminder sepsis

is the leading cause of preventable harm in

children. The national Care standard was

launched this year and we will obviously have a number of indicators that

we need to measure ourselves against

Implementation of a locally approved pathway or

the Queensland Pediatric Services Pathways evidence of Meeting those

indicators and the tool Kit's been designed with all that in mind.

So the pathway toolkit's been tested and co-designed locally

with our clinicians and it aims to assist sites in

implementing and sustaining the pathway.

Finally just to acknowledgments. We have

a wonderful wonderful team of

consumers who help us design and lead the

programs as part of our qpsp. We have

great collaborative and clinical

advisory groups. And as

I said before our wonderful happy smiling friendly

faces there of our multi-disciplinary QPS PT.

Those are encourage you there's an evaluation survey

just there under the right hand side. You can scan it

in. I think cerebral also put in the chat a link without your

feedback. We don't know how to improve. So, please please encourage

you to to do that. This will literally take you two

minutes and there's also the opportunity to give us some feedback

in terms of what future sessions you'd like to see so we'll now

be running these webinars every month and we're trying

to come up with a different theme each month.

So we certainly encourage you to give us some feedback on what else you'd like

to hear from us.

Um and finally just our beautiful family's and

patients affected by pediatric sepsis

and bicepsis. We yeah have

inspiration for these wonderful families who

help us understand the

impact the true impact on them and how

we design our program to make sure it's it's

suitable.

So

that's it. I'm not sure if there's any questions online.

Thanks, Jade. We don't have any questions in the chat about

the toolkit. So if anything comes to mind, please drop them

in now. We do have a few that were pretty submitted we

can get to quite a few around a digital

pathway. So when will the pathway be integrated into the

digital system?

Great question. There's been

lots of design work happening with the IMR

pathway. And yes, we

have been I think there was a couple of questions as you said

Sarah. So yeah following nine months

of design and consultation. The final design was

actually ready to go in October 2021. But

as part of that testing phase there was a technical defect that

was actually identified and so it's now

with the Venda and they are trying to work through

that so the aim at

this stage is the 2023 in

terms of working with the vendor to come

up with a solution to to assess that technical defect.

Exchange another question from paramedics

in the group. How does the toolkit affect them

if at all?

Yep. So the toolkit

I suppose there's all those

education resources and awareness posters. They're

probably the two main things that I would say would be relevant to qas. There's

obviously awareness posters for clinicians

or paramedics but also for families and

stuff as well. I do

know that the screening and recognition criteria of

the pathway is actually been added to the qas and adapted

to their handbook. So obviously helping

that early recognition

and education of paramedics there and I

believe there's

There's on the courses and webinars Link of the

toolkit. There's some links there to some specific paramedic courses.

I believe that Amanda runs. I think it's called parapen and

some other videos and stuff that would be targeted towards towards

paramedics and I think

we've got Sai online who's our medical colleague.

I was just a nice presentation

dude. A lot of work that's gone in it's taken

you and what's a year? I think this too. I just

wanted to answer add to your comment of

the EMR Bruce you who's also our

digital expert within the group is creating

a dashboard for the state

where?

There will be dynamic input of sepsis

cases from each

hospital for a first we are doing a pilot in

qch, but in time it would go

to all IMR sites where you can

Benchmark yourself you can see your own progress.

But also you can see compare it to other sites

same-sized sites and bigger sites

too. So that's also going to help in terms

of these responses to the national

Safety standards.

Wonderful. Thanks sign.

And Sarah any other questions or are we

out of time? I'm not sure people are

sticking around. It is 2:45. We do have a couple more

questions if you'd like me to go ahead and ask those sure. Yeah

sure. So the next comment was often

paperwork gets lost and doesn't follow the patient or get

scanned into the chart on IMR. Do you have any

suggestions regarding these two issues?

Um

Good question I suppose so

I might be able to answer this filming here. You might have some advice as well.

But I suppose it would be understanding what the current

process is. Is there a current run does it have a patient label

I suppose it's a big safety issue if

the if it's not being scammed we

do have some tracking sheets and stuff on the

toolkit as well as those labels that I've showed

you. So I'm not sure if that's something that would assist I'd probably

have a conversation with admin offices

or whoever's within that department and actually understand

what the process is and where that issue might

be where they are getting lost in terms of the process.

So

So I do have any advice there. I mean you digital Hospital

sends Jade. You know how we

were in these Eternal sites there

the incidence of sepsis very

small and therefore you may see one every

month or so the numbers are small, which

means you may need to have an audit sort of

a book which adds to workload. I

guess. That's the first thing to point out for IMR

sites. It would be slightly easier if you

were to put in a pathway and if it was

scanned in

Then you can pull it off the the bi

of your hospital will be able to pull it off. So there will

be a PDF viewer which they can pull and extract data

from so that would be one way of assessing whether

it's being done. I think you pointed out

it's usually who scans it and how we scan.

That's is it to keep it.

But I haven't found we haven't found a

clear solution for that how we did?

No, I just know in some of the sides as you said

we have they have the book like at the nurses station where they're putting

a patient labeling in terms of knowing which patients have

been put on the pathway. And so we've tried to replicate that

in the tracking sheet. So if you'd find the tracking sheet on

the toolkit and that will assist with just putting a patient

label on there. So, you know, what patients were on the

toolkit. Sorry on the pathway that can kind of

be identified later, but I

suppose will definitely benefit from that.

Yeah.

Definitely is probably too strong about but they might

benefit from that sort of a path process for here

because sides QC

it's and others like q-ch. I think

it has to be the pathway being scanned in

and bi then pulling it off the system to

document who was on the pathway.

And I think you mentioned this the pathway

handle what is crucial so going from war to

Ed if someone has been placed

on the pathway or assist on the pathway. I think we could be

encouraged that hand over to happen. And in time

the national Safety standards will encourage

dedicated sepsis care coordinators and each

of the sites

It may not be a new role. It may be

unfortunately someone taking on another role an additional

role but that person may need

to have a view or oversight

of how the pathway flow works and who is handing

over to home and they will be the contact point for

all clinicians all practitioners who

are taking care of that particular child.

There was no Sarah is going to the question. So I'll just

let her continue.

I think we have a time. Yeah, it's to

2:45 249 and I

think we just point this

question does I'm in the as asked as

the current hard copies of toolkit include resources for

families as well as in the clinical Center.

Um so had copies of the resources are

available. So for families those postcards and

the Flyers Family Support flies.

There is definitely hard copies available. So I'll

put in the chat now the email that's right size

holding them up now. So yes, so

they are hard copies and I'll put the email in that you can request request

the numbers. Let us know how many you'd like to for us to

send out. However, they can also be accessed digitally. So

on our website that I've shown today you go to

resources for families and

they're there as well. So sites can print them through their own printers if

they prefer

When so, all right. Well, thanks everybody for your time today

and

Yeah, thank you. Thanks so much for joining and we will

be having another session in November Target around

barriers and solutions so barriers and

Solutions in terms of caring for children with

pediatric sectors, but also around the pathway. So keep an

eye out for that session as well. Thanks everybody.

Thanks.

if you wanna take yourself off mute or talk about that anymore. I know that I'm,

I know that I'm getting you on the spot, but I think it's a really great, um,

great asset that you've done there.

Thank you. Um, and it's been through the, um,

support that I've actually had here, um, through our standard aid lead.

My nursing director is cath frame, so, um,

in consultation with the team here and our sepsis advisory group, um,

it's not just about me. I'm just have, um, tried to coordinate it, um,

and ensure that we can get resources across a quite large, um,

health service covering, um, regional facility, rural and remote.

Um, but it certainly is effective. But again,

it's time and just leading clinicians all the way to go,

this is where it's at and seeking their feedback to improve it all the time.

Mm-hmm. But we certainly like go direct link now through, um,

to the excellent resources there, um, from pediatric sepsis program,

children's Health Queensland, exactly as you said, don't reinvent the wheel.

Mm-hmm. Um, and it's just sharing it because yeah. Um, and the,

and slowly it's coming to fruition, so thank you. But, um, yeah,

it's been with a lot of support, um, here in the health service.

Thanks, Kathy.

I think it's really important to say adapting it for your local site.

So understanding where clinicians would get their information,

how do you raise awareness and I suppose tailoring it so that it is specific to

your site. And that's exactly what Kathy and,

and the team have done at Darlings Downs, as you said, you know,

on the Quips website specifically for Darling Downs, it's probably, um,

the first point of call that people access for information.

And so it makes sense, um, for it, for it to be there.

Um,

any questions or any other stories people wanna share in terms of how they've

raised awareness, um,

of pediatric sepsis at their site or anything to do with how you've made,

um, the pathway sustainable?

We need some thinking music, don't we?

It's Kathy here.

Like the best thing that we've actually had our SEPs are our sepsis champions

out in our facilities. I mean,

it doesn't matter whether they're most the least experienced or the most highly

experienced,

but once they've actually got a passion for it and they've had some experience

with it, they just lead the way. And I'm really impressed, um,

at how they do it and working with clinical facilitators and, you know,

everybody, it's just actually, um, you know, sepsis is on everybody's, um,

focus. And I mean,

and the other thing is it also generates it from a community perspective as

well. And like, you know, even admin staff, like, I mean,

I remember sharing resources with admin staff and they're going, oh,

I didn't know that about sepsis.

And it's actually just sort of trying to promote that conversation,

get it out there into the community. Yeah. Um, it's not about, you know,

doing massive big PowerPoint presentations. Keep it simple. Um,

here in Darling Downs, we've also developed some sepsis messaging cards,

you know, take one, give one. Um, so yeah.

Wonderful. Thanks Kathy. And we've got, um, oh, that's nice,

Katie. We've got Katie East online who's, um, what they've done,

I think Katie's based at Logan is creating a sepsis group, so inclusive,

inclusive of lots of, um, different, uh,

clinicians including CNC SMOs and creating those champions that will really

drive and lead the way, like Kathy has said.

And it looks like they've got wonderful little, um,

everyone loves something free, a sepsis champion badge by the look of that,

that's that Katie has posted. Um, so obviously that would, um,

easily identify who the sepsis champions are, um, and they, they look fantastic.

So, um, with three minutes left, um, we've definitely had some, um,

wonderful other ideas and solutions and, um,

questions from people online. I think we'll go back to,

I think there was an earlier question, uh, when Karen was presenting. Sarah,

do you mind, um, repeating what that was? I think it was from Molly,

maybe.

Yeah, sure. It was from Molly. Um,

it was a question about engaging with community elders.

If the patient or family requested, how would we go about doing this?

Can you answer that one please, Karen?

Yeah, sure. Um, so yeah, linking in with your, um,

indigenous hospital liaison officer or your health workers within your, um,

you know, your organization. So that's, you know, they should be familiar with,

you know, who their elders are. Yeah.

Wonderful. Thanks Karen. Thank you all so much. Obviously,

if there's other, um, solutions you want to share, um,

or barriers that you, um, um,

haven't heard about today and need to workshop it out or talk to us, then,

then certainly send us an email. Um,

I'd just like to acknowledge obviously our fabulous consumers and our program

team, um, and all of our different, um, committees that, um,

that help us achieve our goals. All of these are now recorded as well,

and they're all on our website,

so you can share them with your teams or watch them on demand.

So thank you all very much. And I'd just obviously like to just highlight, um,

our beautiful, um, consumers and families who, um,

who contribute to our program, um, and share their, share their stories, um,

so generously, uh, and, and it's why we do what we do.

So thanks everybody for joining today.

Well, thank you everybody. We really appreciate the fact

that you've given up your your lunch time.

I hope you do get some food and and get

a break. So thank you all very

much.

Oh, no, there's one more hand.

To Linda is your hand still up or is it a new question?

Oh, no God, it's Celine

here from caboolture. I just wanted to say the adult pathway. We're

actually working it rolling that out this year

before June.

Cool for the impatience. Yes.

Oh, baby, that's great.

Thank you. Oh Statewide.

Alrighty. Thanks everybody. Thank you.

Thank

here. So yeah just a bit

so that does still exist. Okay speak to

this too. Yeah. Hi Jenny. Sorry. I've been scrolling away

underneath. I'm the manager for the Pediatric success team

and excuse my voice at the moment. But yes, there is considerations and

the antimicrobial guidelines. If

you have a look specifically on the septic shock

line, there's a specific line that says except for

final Queensland during the wet.

Wet seasons, and then it has specific recommendations for you, and we

do have some great consultation with our colleagues up

in Far North Queensland, and you might have seen a draft version it

that wasn't included. But this vinyl version.

It's definitely included in there fabulous. Thank you. You're welcome.

Just one more of the chat Amanda do we know or is

there some way for people to find out who the steps is coordinated are

for each hospital and Health Service or site. Yeah. So

my recommendation there would be to speak

to patients' safety and would be

my first Port of call around that. So this is quite a

the clinical Care standard obviously recently came out

and but those facilities are

probably up and getting wheels around organizing those

sorts of things. So I would Link in

with patient safety at your respective facility wherever that is

and or also your perhaps and

nurturing management or your assistant director of

nursing wherever you are. Obviously, let's be slightly

different Pathways, but they would be the people I would ask who

maybe around have a bit of knowledge around that or if you've

got a standard eight working group. They also maybe

able to point you in the right direction. But yeah,

very hospital is slightly different governance it up on

Who would know those answers, but I think one of those three

People depending on where you are would be at a point in the right

direction and don't be surprised if the answers. Well,

we actually haven't thought about it or we don't have one. This is

a really great opportunity to get those Wheels in Motion

and start to figure out how can we make these people

exist Within These facilities?

So later, you have something to add probably.

Oh, no, great. Great presentation guys fantastic as always.

Um, just a question now. Am

I understand this pathway is for Ed and the

wards as well. So it's a one one pathway. Thank goodness. Thank

you. That's brilliant. So now I'm just going to be starting to

do some more education on our Wards and nades just

to make sure there's the same

wink code.

No, it's a different wink code Celine. I'll

post in the chat those fact sheets and frequently Asked question

guides now which have the wink code on there. So yeah,

so the old the two wink codes for

the rule and remote and the old Ed one will expire.

So they won't appear on the catalog anymore. So there is a new wink code

for this revised pathway. I'll post it in the chat lovely. Thank

you.

And also Selena just to confirm for anybody who isn't from

Metro areas. This Papo is

also for real and remote sites as well. So we've had extensive consultation

with Rural and remote clinicians to make sure that it's applicable for

their sites to

I just want to comment on a comment the

same mobile Fiona Thompson in the chat another question, but a

comment Amanda you mentioned that sometimes despite optimal early

recognition and aggressive treatment with the bundle these patients deteriorate,

of course on a rational level. We know this, but the

clinician guilt and grief can be profound and I think it's great to acknowledge

that I think that's something that was certainly all very well and Amanda. I

wonder if you just want to make comment about the possible referral for

services for support through our referral form in you

know, in terms of accessing support from our team when a particular

incident does occur.

Yeah, absolutely. Yeah. No, thank you Fiona. I'm

glad that's being said.

I hope yeah, that's exactly I hope to put that

in there and get that across in the presentation because yeah time

and time again, we do things really really well and unfortunately,

it's just the nature of sepsis and we rack ourselves

and just yeah, it's awful. So thank

you for also, yeah reiterating that mention so

I think given that it's helpful sometimes

to discuss things to walk through things to

review cases. Obviously each hospital has different processes around

doing that but certainly as the sepsis

Pediatric Services Program. We also

here to support through that if that is what you would like. Okay,

of course, we don't know about these unless unless

you reach out to us and that

has certainly been done in the past. But very very

happy this this really is important and supporting

clinicians through this process is really

really important and something close to my heart as well.

So we do have a referral in place

around that and I might go through

sticks

the latest version

Yeah, sure. Once again, if you go to our sepsis page,

there's a link there request for QPS P support and

basically it's an online form. So people are

now pretty familiar with teams and office. I

think so, there's an online form that we just asked for a little bit of information in terms

of what pathway you're currently using what kind of

governance and structures you currently have in place and

there's no right or wrong answer. It's really just allows us to kind of

see where you're at in terms of implementation and how we may be able to support you

and you can obviously select what level of

support you want. You might want education you might want, you know

family support you might want just a question on what pathway

we're up to. So there is the option for just providing

a little bit more detail on how we can support you.

And I think in your brain as well exactly that you go. I know

I did everything I possibly could.

But just having someone to discuss that to review to

look at pointers all of all those little things

and to go you know, what this this outcome may

not have been able to be changed and this is

affects our practice for years to come and

so really discussing that I find helpful

and being able to move forward and not

getting a bias and a whole different sort of a way. Thanks

for you.

I would just add a quick plug if I may that I'm

also in that same area which you can find on quips

as well is that you there's now referral form directly. If you'd

like to refer a family through to the QPS P

who to then access support in

terms of being connected with other families accessing information

and resources and being able to have direct contact with myself

and my colleague as social workers on the team to offer

that ongoing support to families. So have a

look for that as well.

Any other questions?

Just one in the chat about is there a wink code for the

sepsis checklist and parent and Care information sheet.

Not that I'm aware of. Hey, did we

have one for the old checklist? And are we

intending to do it for the information sheet or would we just expect sites to

print that offline and question? Yeah.

There's a question. There's no direct Wing code for those resources.

They are they are part of the pathway. So

when you order the path where you'll get the resources, and if you

just want the resources to sit by themselves, they're available on our website

to print and users your place.

Thanks, Karen. Alright, we might come to

a close. They're five minutes overtime, but really valuable conversation

and discussion there at the end. So thanks everybody for

joining. We'll get Sarah once again to send out the recording

link and the slides from today and we

might get her to kind of summarize all of the resources. We've been

putting in the chat because there are quite a few there.

You know that you can use that at any point. Once again just you know,

email pediatric acceptance at health docqid.gov.au for

any other questions or support and we have posted the evaluation

survey in the chat as well, which would be really wonderful if

you could could complete that.

There's no other questions. Oh, yeah.

It's off. Thanks everyone for joining. Thank you

everyone. Good luck.

Thanks. No. Thank you. Thanks.

standard next month on August. We're running

a session on the 11th of August and on the

25th, it'll be advertised through the same channels that

you found this or you can also follow the Eventbrite

page, which I will post in the chat. Matt session

will be all about data and metrics so a

good follow-on session from this in terms of how how we

can help you collect information

and the local monitoring and the importance

of that and also talking about documentation matters and

and documenting sepsis and the ICD-10.

And that will be led by our wonderful AMS pharmacist Mel

and other medical lead Adam Irwin. So

thanks everyone for joining reach out if

you have any questions, but just to reiterate what Paula said we're here

to support you through this. So any any questions,

please reach out. Thanks everybody. Thanks everyone.

Good luck.