Paediatric Sepsis Series — Barriers and Solutions

Transcript

So, um, before we get started,

I'd just like to acknowledge, um,

the traditional custodians on the land in which we meet today.

And I'm joining in from, uh, the Gold Coast or the Yaba region. Uh,

I'd like to pay my respects to the elders past, present and emerging, and also,

um, re uh, acknowledge any Aboriginal Torres Strait Islander, um,

peoples who are online today. Um,

so the session will discuss the common barriers, um,

sites have experienced in the recognition treatment and ongoing management of

pediatric sepsis, um, in alignment with the pathway. Um,

we'll obviously offer some solutions, um, that we've,

we've experienced from the, from us, the dedicated team. Um,

and I'll also provide you a little bit of context, um,

around who's online today and what our program is aiming to deliver. Um,

so based on our experience as a team, as the Q P S P over the last few years,

um, we've obviously done a number of site visits and held meetings like this,

engagement with community leaders and surveys and discussions.

So the barriers that we've identified today is based on our experience over the

last few years and the things that we've heard from you,

which are common barriers and the solutions that we've come up with.

Thanks, Jade. And yeah, as mentioned, unfortunately,

our incredible advanced social worker, Alana, is unwell today.

I'm gonna try my best to fill her very big shoes,

but if you do have any really specific questions for, um, for a social worker,

please reach out to us. Um, and as soon as Alana's back on her feet,

she'll be able to answer those for you. Okay.

So the first barrier that Alana has come across is, um, this one.

So I work in a rural setting and families often return home following discharge

from a tertiary hospital,

and they've got little information about what sepsis is, um, uh,

and what their diagnosis means for their child and where to go for support.

So to try to help with that barrier, um, Alana and the team have developed,

uh, a lot of resources. Jane, if you could go to the next slide, please. Great.

So you can share information with families. Uh,

you can share the link on our Sepsis in Children website, um,

where they'll find a wealth of information about sepsis and available resources,

the website's accessible to anyone wherever they live in Queensland,

and even those, um, uh,

people and families who've access to Queensland Hospital,

but maybe live interstate. Um,

and it includes information that's relevant for families located in regional,

rural, and metropolitan settings. So, in particular,

it would be great if you could please share our journeying three sepsis video

series and also the link for our, um,

novel peer mentoring program as well.

So the journeying three sepsis video series was developed in response to direct

feedback from families, uh,

that they need consistent evidence-based and timely education.

It's an eight part series,

and it aims to support families by providing information and guidance on

each stage of their child's hospital journey.

So that's from the initial diagnosis through to intensive care and rehab,

and then support for the child and the family after discharge.

The messages are provided mostly by families who've had a child diagnosed with

sepsis,

and there's also some key clinicians in the videos as well who work in these

specialist areas.

The four families in the videos have children from a range of ages and

are from metro, regional, and rural areas as well. Um, they've,

these families have bravely and kindly shared their stories,

and we encourage that their lived experience is at the forefront in these

videos,

validating the real experience of the burden of sepsis on these families.

Uh, and also reference was our peer mentoring program,

and that provides families with a child diagnosed with sepsis, both, um,

surviving and bereaved with an opportunity for validation and normalization of

their experience by connecting them with a family member whose child was also

diagnosed with sepsis more than two years ago.

Our peer mentors are parents and carers who have firsthand experience with the

challenges faced by families with a child newly diagnosed with sepsis,

and hence can assist them in navigating this experience. Uh,

the peer mentoring program can be offered to any family within Queensland,

and families can self-refer by registering on our website.

Thanks for popping those links up, Jane. Uh,

we currently have seven trained mentors across both the bereaved and the

survived spaces,

and they're ready to be matched with new families with a child with sepsis.

Now that you know about them, um, it would also be great, uh,

if you identify any gaps where you think these resources are great,

but what's really missing is support for this particular area.

We'd love to hear from you, um,

and to help develop something to help fill those gaps.

Okay. Let's move on to the next barrier.

So,

quality statement five states that we need to provide the patient and carers

with education and information. So how do we do that?

And if we can move on to the next slide. Thanks, Jane. Great.

So the commission has developed several resources to support the

implementation of the new sepsis clinical care standard.

And some people may also not know about this new standard either.

It was released in July. Um, and there is specific recommendations around, um,

patient, family and carer information and education.

So as part of that,

there's a number of case studies that illustrate best practice and innovation

within sepsis care. So the study that's highlighted on the slide here, um,

it's implementing a pediatric sepsis program in partnership with families

affected by sepsis, and it's available on the Commission's website.

If we could pop that link in the chat, please.

And it explains in detail how to easily access a wealth of resources

for information. Uh, and this is a national, um, uh, page as well.

This isn't just specific to Queensland, so there's lots of information on there.

It will walk you through the process of how to inform and support families,

and it provides numerous links to available websites, including fact sheets. Um,

the previously mentioned video series, public awareness resources and more.

Uh, as a team,

we're also ensuring that this focus on providing patients and carers with

education and information is at the forefront of everything we do. So,

as an example, the soon to be released updated, uh, pediatric sepsis pathway,

it will now include two tear off sheets for families and carers and parents.

One will be for carers if their child is discharged from the emergency

department, um, that they don't have sepsis,

but they need to continue to monitor for signs of sepsis.

And it's a fantastic easy to read checklist so that those families are empowered

to go back to emergency or back to their GP if they know that something's not

right or if their child is getting worse.

And the other is for carers of a child with a newly who are newly admitted to

hospital with sepsis. So it's a guide for care. Um,

it explains what sepsis is.

It provides some key questions to maybe ask their health team,

which they might not have thought of,

particularly in that really acute phase when, you know,

everything's very overwhelming. Um,

it explains who might be on their healthcare team and what might,

what experiences they might come across in the next, um, few days. Uh,

does anyone have any other ideas on, um,

how or what type of resources we can provide to, um, families, carers,

and parents, um, even maybe with the outside of the sepsis space?

Does anyone have any ideas of other resources or information or ways that we can

engage with families? Oh, thank you, Molly. Just need one to start it off.

Um, referral to social workers. Absolutely. Further support, a hundred percent.

So Alana is working really hard in both establishing a network of social workers

within the hospitals across the state, but also upskilling, um,

social workers around sepsis and sepsis support, um,

particularly for families who might have needed to go to a bigger site in a

returning home,

or maybe even for those families who are able to be managed locally at their

site as well. Molly, that's a great idea. Thank you.

Um, Carissa's got a question about non-English speaking documents. Yes.

So very good question. Um,

from a public awareness and health promotion point of view,

we do have translated sepsis resources.

So they're translated into 10 different languages. Um,

we develop those in consultation with the MATA refugee, um, health Network,

um, uh, so that the language, uh, for those signs and symptoms,

um,

was easily translatable and something that makes sense to non-English speaking,

um, communities.

But it's a very good point about those families who are then diagnosed with

sepsis. So our next, um,

step will be around translating some of those resources for families, um, uh,

in that, um, management side of sepsis. Yeah, uh,

we'll pop a link in our chat as well for, um, those translated resources.

They're available on our website and they're also now available, Sarah,

correct me if I'm wrong, they're also available on a national, um, uh,

health database for translated resources too.

There's fact sheets and website, uh, sorry, fact sheets and videos.

So they can also be shared. They,

they were developed specifically for social media as well,

so they can be shared on, um, any, uh,

if you know of any culturally linguistically diverse, um,

networks that might like to share them,

they're very easily shared and publicly available.

Thanks for the questions.

All right. Um, if there's no other questions on that one,

we'll move over to Karen.

So there's been a couple barriers that have, you know,

come to our attention and I just wanted to, um, you know,

address them today and carrying on. Um, I will, you know,

continue on from Kate's questions. I wanna, you know,

put the questions straight out there now is to, um,

if anyone is unsure how to support Aboriginal Torre Islander families in their

communities. So you can see the map there. Um,

the indigenous Australia map, so that's all the tribes, um, you know,

throughout Australia. Um, so you can just, you know, Google, but I think it's,

I'm not quite sure where it's from. Uh, okay. Um, and we, we,

we also have, you know, nacho, which is na,

national Aboriginal Community Control Health Organization.

So you can always find your closest Aboriginal Medical Unit surface. Um,

and we, you know, also have resources, you know,

developed for Aboriginal to Islander staff and their communities. Um,

so some solutions I've come up with is to connect with your key community

members. Um, our team can point you in the right direction. Um,

and with that map, you know, you find out which country you are working on,

um, link with your hospital health service, first Nations contact,

and AB Agricul Lander Health Community Control organizations.

And you can use a culturally appropriate resources on the, on the sepsis, um,

children's website. Um, and you can always reach out to us, uh,

to our team for more support. Um,

and there's also culturally, uh, capability officers, uh, in your organization.

So that's another way to reach out too. So I guess I'm just asking, you know,

what do you offer or, um, at your, you know, site,

you know, how do you support Aboriginal Islander families, not just with,

you know, sepsis, but with, um, anything

Karen, do all sites have, um,

Aboriginal Torres Strait Islander workers for support?

You talked about cultural capability and, and,

and would they be available within HH s's or specifically

or particular sites or,

Yep, they're everywhere. Yep. Might be on their site,

but they would cover their site, Jade.

Yep. And how would you find them, Karen? Is it just a, a quip search or

Quip search? You can get it onto your director of Indigenous health.

You can always, you know,

link in with me on the email address they're provided and I'm happy to

reintroduce, you know, you Yep. To them. Yeah.

Wonderful. No other questions.

Hello? Sorry. Hi, it's Nikita.

I'm one of the doctors from Roma Hospital in Southwest. Um,

I just wanted to say like, we have fabulous,

absolutely amazing Aboriginal liaison offices. Um,

we've got three plus our director, uh,

and they are always super helpful with patients in general. But, um,

you know, pediatrics particularly, um,

I had a case not that long ago of quite an unwell child that we retrieved to the

Children's and they're, uh, they identified as Aboriginal. Um,

and our alos were just excellent.

There was lots and lots of social stuff going on. Um,

and one of our alos is a mom herself, so she could relate really well. Um,

and it was just really good to be able to offer that support to that mom who

was in a really hard situation.

Oh, that's great to hear.

Wonderful. Thanks for sharing, Nikita. That's, that's excellent.

No worries. Thanks.

So the next barrier, um,

is I'm unsure how to engage with Aboriginal Tor Strait Lander in the families.

We've just been on a recent tour, um, up to Cooktown, um, in TAUs and Cape,

and we, you know, reached out to many, um, um, you know, little,

what do I call it, little one-stop shop. I guess the only, you know,

people in town, the first responders is the word I'm trying to think of. Um,

yeah, they do, you know, hell of a lot. So, um,

so some of, some of the solutions that, um,

I've come up with identifying early that they are aboriginal to islander, um,

always acknowledging, you know,

the country you are talking on or actually meeting,

showing interest in local community events. And I'm sure, you know,

being out in, you know, Raymond Akita, you know,

you would always attend these community events being a small town. Mm-hmm. Um,

building positive relationships,

attending community events and joining on community projects, um,

engaging with your community, understanding social,

social determinants of your community,

being transparent and most of all, you know, building relationships,

um, because that's the key. If, if they feel safe, they're gonna open up,

um, yeah. With you. Uh, also, you know, linking in with key community people.

Um, and, and as Nikita mentioned before, um, you know,

the hospital liaison officers, um, and, you know,

having that lived experience as well as a mother, um,

and engaging with your local community elders is the most important one out of,

you know, how to engage with our families.

Thank you.

Wonderful. Thanks Karen. There's some, um,

excellent ideas there and wonderful to hear, um, from Nikita as well.

Uh, I believe it's over to you, Amanda, talk. Talk us through, um,

some barriers that you've experienced in your nursing world for sometime now.

Thank you. Thank you Karen as well. Okay, so we've got acquired a group,

um, and I'm pretty sure this barrier will not shock you at all,

so we're gonna have a little bit of a discussion about it. So we have,

it can be challenging to obtain a medical officer review when I've screened a

patient on the sepsis pathway. Now,

can I have a big emoji thumbs up if, if you have experienced this,

and if you're a medic in the room where there are a few of them are,

this may shock you as well,

but not everyone is as open to the sepsis pathway and having nurses present them

to them. So I wanna see some big thumbs up,

or I'm gonna go really shy and stop talking and that may be a good thing for my

team, but Perfect. Thank you.

So who has experienced this wonderful, well, not wonderful,

but let's have a little chat about what we can do to combat this.

This is a really, um, big area and there's many,

many things that we can actually, um, talk about here,

but I've broken them down into a few little dot points.

So the biggest thing around this really is increasing buy-in.

Now that is, um, relevant to nurses, that's really relevant to medics,

but what we really wanna do is debunk some of the myths that go around a sepsis

pathway and what it is that it's actually trying to do.

So it's about shared understanding, communication and,

and really outlining the purpose, um, for such.

So the first point to just bring up is the surviving sepsis campaign guidelines

for many, many decades have recommended, um,

all institutions implement a systematic screening tool globally.

So whether you're in the United States, Europe, Australia, wherever you are,

that we have some sort of systematic screening tool in place. The critical, um,

the clinical care standard for Australia was released a few months ago now,

and it absolutely recommends the same thing. Now that being said,

we shouldn't just do something 'cause we're told to do it. Um,

and we should also raise questions and be curious about that.

But the evidence for pathways and screening tools is quite strong

internationally and certainly nationally. Um,

and we've obviously done some work on that in the last few years with the sepsis

collaborative. So given this evidence that's worldwide and,

and the challenges with early recognition in pediatric sepsis,

this tool really acts as a cognitive aid. Um,

it acts for whether it's junior nursing staff, um, more experienced staff,

um, junior doctors, whoever it may be, even for a more senior doctor.

It really assists in that decision making and acts as a risk stratification

tool, just like we have for, um, chest pain pathways, for example.

The other thing that may come up is that, um,

the pathway is taking away a medical officer's clinical judgment.

So that's absolutely not the case at all. Again,

it's a risk stratification tool. Um,

the medical officer is the one at the end of the day who decides if this patient

has sepsis or not. That decision sits with them,

doesn't override their clinical decision or judgment. Um, it purely is,

is something to put in front of their eyes. Um, and to really ask the question,

could this be sepsis in the early stages?

The next part I wanna bring your attention to is, um,

that just because a patient's being screened on the sepsis pathway,

it doesn't mean that they are on the pathway and that all treatment must be

delivered, um, in line with sepsis management principles.

The screening tool is exactly that. It's a screening, um,

to identify severity of illness features.

And then that decision goes to the medical officer,

whether they have sepsis or not. There's, um,

some misconceptions about an increased workload, which is also not true. Um,

and we've also got data to, to back that up over the Queensland, um,

collaborative that happened a few years ago. That also being said,

if the child doesn't have sepsis, but they have a feature of severe illness,

I can bet some money that the medical officer in the room would wanna see that

child regardless of it being sepsis or not. So for example,

as we can see on the screen, if a child's got a, um,

respiratory score of three or greater in line with acute,

they would wanna see that child. So again,

it acts as a common pathway to present that to a medical officer and say, look,

this is what I'm concerned about. I'm not sure this could be sepsis.

This is what the child is flagging, um, and can you please come and review?

It doesn't diagnose it. Again,

it flags that cohort of children where they have feature of severe illness to

get that senior medical review early.

We also need to remember with sepsis that, um,

we have catastrophic outcomes for children. It is an uncommon thing,

but when it does happen,

the outcomes are catastrophic and the children can begin with very normal

physiology, um,

and very subtle changes that are incredibly difficult to pick up on. Again,

this is where a screening tool really helps us and puts us on guard.

Lastly, if you screen the child, they don't have any features of severe illness,

this absolutely acts as a vehicle to give, um, the patients, um, the family,

a parent leaflet to say, we don't think your child has sepsis. However,

they have an infection. We're a little bit concerned, um,

if they're going home or if they're being admitted wherever they may be.

Here's some information about sepsis, about what it is.

We know that community are a massive player in this game. Um,

and knowledge is power for them to know when to bring their child back.

So there are some solutions, um, that I can think of. Has anyone got any others?

A few people said they haven't had this problem in their areas,

in their departments. Would anyone mind sharing what they did to, um,

obviously not have this issue at all? If you're doing something right,

Just on the barriers, if we, I,

I just visualize times when I have been the barrier as the clinician

who's been called to review a patient, of course it never happens,

but when it does happen,

it's invariably because of the shared mental model that we lack. I think,

um,

it may be that I'm in a new team and I don't trust the team yet and they don't

trust me. Um, and therefore they've had to use a a pathway to,

to direct my attention.

Maybe I'm very busy and have 10 things that I'm doing at the same time,

uh, numerous reasons why it may come across as a perceived barrier.

Um, but if as a group of clinicians a priority

as a team, they decide that this is a good thing for the department to do.

And if there is buy-in from the clinicians as well as the managers,

then I think, uh, it becomes easier to circumvent the barrier.

And certainly the pathway empowers the nurse to

one,

maybe it's a junior doctor who's just come on to the pediatric rotation and they

haven't seen any children before. So this will guide them. Uh,

a senior nurse comes with the pathway, and so the junior doctor learns quickly,

but also when the junior doctor then picks it up and calls the consultant at

home, the consultant already has this frame in their head, and this,

the junior doctor just says, actually on the pathway, I would found X, Y,

Z as the issue.

And therefore they can make a decision over the phone when the

decisions are then made on objective measures as opposed to the perception of

the person who has not seen many sick children before. So I think both ways,

it helps first escalation or guidance of the junior doctor or,

or the ss m o who has not seen many kids maybe,

but also escalation further up the chain.

Absolutely. Yeah. No, thank you. So I think it really highlights the, um,

importance of the multidisciplinary team in, in this, um,

and having that exactly shared understanding of what it is we're trying to do

together collectively. Um, and also knowing we're all individuals. We are all,

you know, doctors, nurses, social workers, and program manager, whatever we are,

but each person's experience will, will bring different things to the table. Um,

and if you're not getting traction, you can escalate to another,

to someone else. That certainly can be useful as well. Or we,

we can reframe the language that we are using.

All right. We'll move on then to the next one.

So our next barrier is around, um,

screening on the pathway. Thank you.

Okay. So I'm advised if I screen the patient, um, once on the pathway,

then I don't need to do it again so that it's an entry and an exit point and you

never have to pick up that piece of paper, um, again for that patient.

So this is actually a misconception, um, that is not the case at all.

You may only need to screen the child once,

but you absolutely can do it again if required.

Could I skip the next slide please? Thank you. So, as we know,

sepsis is an evolving beast.

It can declare itself at any stage of the patient journey,

and that is it why it's just so incredibly tricky and why it's difficult to

recognize early.

The thing I always like to remember is the child has a simple infection always

until suddenly it's not. Suddenly it's sepsis.

It's an unwell child who may or may not have sepsis,

but it may be too early in the trajectory of that illness for sepsis to declare

itself.

One of our tools that we can use to allow that to be in the forefront of our

mind is to use a screening tool, a pathway, um,

and certainly ruling it out early instead of ruling it in late.

If you're in doubt, if your gut instinct is screaming at you, if,

if you've got a differential diagnosis, a diagnosis that you're working towards,

they may be admitted in the ward, they may be in the emergency department,

they may be at a primary health clinic, wherever they are.

The treatment that you are giving this child for this diagnosis that you're

working with, is it behaving consistently with that diagnosis?

If the answer's no, if you've got that, um, clinical gestalt,

ask the question again. What has changed? Could this be sepsis?

Why are they not improving? And what other differential diagnoses are out there?

You can absolutely rescreen again, then, and again,

it acts as that cognitive aid.

We know that patients and pediatric patients especially change really quickly,

but it reorientate us. It puts the team on the same page again. And we go,

you know what? We thought this was bronchiolitis.

There's bronchiolitic elements, absolutely.

But we also think we are now treating for sepsis.

What is the big picture in the children that we're treating? Think outside. Um,

don't have, don't overanalyze it. If you ask the question,

try and climb through the screening tool, it takes about two minutes to do.

The other point about that is that, um,

the child that you see in front of you that you screened two, three hours ago,

or maybe it was someone, um, on a different shift that screened them,

maybe incredibly different to the one that you see in front of you. Now,

we know children deteriorate really quickly,

and it's actually quite shocking if you if you've seen sepsis on the child that

you saw literally an hour ago, perhaps, how can that happen?

But that is the beauty, well, not the beauty that is the nature of sepsis.

So if we only screened once and the patient then deteriorates,

and now they're shocked, we've absolutely missed that window of opportunity.

So that is one of your, um,

best friends in relation to keeping it at the forefront of your mind.

And there's children that are just a little bit difficult.

So can I just either have a thumbs up or a comment or a response?

We'll try for the last time. Um,

if you have seen a child rapidly deteriorate and you think that certainly asking

that question again, um, may have helped in that earlier recognition.

Excellent. Thanks guys.

So many things that we can really talk about in relation to all of this.

Certainly happy to talk about it, um, uh, later and at the end, um,

we can share. Um, but very,

very interested to hear your thoughts and everything as we move forward.

So Amanda, this,

this actually does flow on from your previous barrier comment.

Let's say a, a junior nurse picks up the pathway,

sees five risk factors were ticked,

and for some reason got barrier and did not get escalated.

But if they go back and review the patient, click the pathway this time,

and they find that things are changing for the worse,

that is a strong message that they can then go back to the clinician and say,

yes. The first time around you said, no, but I'm still worried.

And look at this, my, I have tangible proof or objective evidence, so to speak,

to defend my gut instinct.

And that might get a better buy-in.

Yeah, that's a great, yeah, that's a really great add I think as well. Um,

escalation to, um, retrieval services,

escalation for regional rural facilities as well, where, um,

doctors are on call, perhaps again, really, really good tangible evidence to go,

you know, something, something's actually changed.

And instead of just having the one song sheet to go from,

you've actually got the benefits of paper. You might have one or two,

and it might just be something ever so slightly that has deteriorated what get

what makes you go, no, we're not happy with this.

This is what I need to advocate for. So yeah, that's a really good ad.

Thank you. So, okay,

we might move on to s

Um, I,

I wrote this as my perception of what the

barriers are. I, um, I, I,

as part of my job,

I receive calls from retrievals to facilitate children who may be

deteriorating in different sites. So that's how I came up with these.

Um,

so here the maybe box which essentially follows on from what Amanda was saying,

so I'm unsure how to decide which patient falls into the pink box. Maybe box,

uh, no clear signs to suggest of sepsis. So Amanda, actually,

could you go back to your pathway so we can actually, the slide that you had.

Um, so we can actually see which, uh, box I'm talking about.

The back, I think. Yeah, that one. Thanks. Um,

so here, so as a clinician, also a senior nurse,

um, you've done your screening, you've done your recognition,

and you've done your ops. Um, and it doesn't fit.

There's, there are none of the features, or at least a little bit there,

there it says no. Do you still suspect sepsis? Yes.

So this is a tricky one. Um, and I think this,

uh,

teasing out children into this pink box here in the middle

takes expertise and experience. I think, and this is where I find, um,

certainly when I get these calls and I,

I say to the maybe a junior person, I say,

can you get your consultant in?

'cause it may be that the consultant sees them and says, actually,

I agree with you.

None of the screening or recognition factors are triggered sepsis as

a marker here. But having done what I've done for this long,

I actually think this is septic,

or this is a kid who at high risk of sepsis,

so we should go on a default strategy of managing the mass sep septic

child, at least for now. And so that certainly needs, uh,

a senior medical review.

And that's where this for this box is all about expertise here.

Before this, it was all history, clinical signs and symptoms,

but herein really expertise comes into play.

And so the barrier here will be you are in, uh,

distances between three setups. They are managing a sick patient on one end.

How do you then assess this patient?

How do you get that senior eye onto this child, uh, quickly?

And my suggestions would be around telehealth.

So we have managed to get on telehealth fairly quickly,

uh, as pediatric medical coordinators through R S Q, uh,

or it may be that the senior doctor who's covering the other sites is able to

come online on a FaceTime or something even that would be, uh,

helpful in these scenarios.

Is my way of dealing with this instance where you are in a rural remote

setup where, um, senior medical review is not accessible quickly.

Uh, that was, that was my take on that. And I, I,

I say that with a huge caveat that I do not practice regularly,

so I actually want to seek opinion. Um, Lisa, I,

I note you were in Caboolture, aren't you?

That's not that rural or remote either, but do you have

Oh, it seems like it sometimes. So,

Uh,

We far, we're far enough on the outer metropolitan edge that it, uh,

the quickest I've ever had a retrieval up was for a cardiac baby who was

reintroducing their a altar.

And the train still took an hour and a half to reach us,

and that was at a no traffic to deal with in a good time.

So, um, we do sometimes feel a little bit isolated,

though often people have the opinion, oh, you are close to Brisbane. Um,

it doesn't matter whether you are in a ward in charge, in, you know,

in the ed, you know it,

if you are away from that tertiary kind of nursing and

medical experience with all the bells and whistles, um,

it doesn't matter how big or you know, whether it's half an hour or five hours,

it's still a, a very isolating experience sometimes at three in the morning.

And, and, and Lisa, so the,

the suggestion that maybe telehealth could help in these instances or a call

could help or actually getting, because I,

I don't know how Caboolture works, but there are instances where I call and say,

has your consultant seen this child? And unfortunately,

50%, more than 50% of the time, no,

they haven't because the doctor hasn't called them.

Yeah, there's my practice is that, uh,

when you registrars start,

I give them my list of non-negotiable.

You will call me in the middle of the night if you start high flow,

if you start bubble C P A P.

If anybody looks as though they might need retrieval, I need to see them.

You do not to speak to retrievals, you call me. Um, I'm fine.

I stay at the on-call house up there. I live in Brisbane. I work at Caboolture.

So it takes me five minutes to get in. Um,

and you know, sometimes they'll give me the information, I say, ring retrievals,

I'm on my way in. But sometimes, you know, they're,

um, you need, you know,

the only thing that's been shown to sometimes make a difference in sepsis is,

um, the eyes of an experienced clinician. And, um,

I've, uh, I've, I'm now in that, that, um,

group as a, an experienced clinician,

I suspect there's people on this video conference that weren't born when I

graduated, uh, with my medical degree, uh,

well over 30 years ago. Uh, so yeah,

I, I'm a great believer in telehealth. We've, I've used it, um,

quite a few times, um, with regards to,

and sometimes it's hard to,

sometimes you're looking at the obs and they're not the observation I

had. I know of one child that I had, and the acute was acute was zero,

but the child was sick.

They had a duodenal obstruction. They hadn't started vomiting,

but they were sick. And I looked at the child and said, this child's sick. And,

um, took a bit of pushing,

but this is, mind you, this is a, this is,

this is long before we could FaceTime. And we had the technology to do that.

And when the registrar came up, he looked at the child and went,

and so did the nurse, and they went, oh, this child's sick. Um, so

you use all your senses in practicing medicine and, um,

your visual impact, and it's not something that you can, um,

you know, teaching junior doctors what a sick child looks like.

It's easy with the ones that are, you know,

in the purple stream. Um, it's, you know, the,

the child who's bouncing off the walls as well. It's that area in the gray.

You've made it pink, but it's the pink gray areas. And

that's a very hard thing to actually, it's impossible to teach.

Point about the senior consultant review. I do worry, um,

there are several,

I I saw people from tour escapee logging into that senior medical

review. Uh,

I think yours is uniquely so where you are actually on site five minutes away,

um, majority of the places that, um,

care for children very occasionally mind you don't have that access. So,

um, even a phone call,

even a telehealth conversation would be still worthwhile.

And the other thing which I was hoping we could discuss is the nurse who

has done this for 20 years, um,

when the junior doctor thinks they know better, occasionally that happens also.

Um, they could then say, look, this,

this kid I think is actually here in patient may have sepsis box,

and I do think we need to bring you a consultant onto this call or review.

Um,

and maybe they can use the pathway in that,

that format to get the consultant review. Sorry, my end is a bit noisy.

I'm gonna keep, am I unmuted?

One of my mantra so is, um, excuse the French,

don't p**s off the nursing staff.

I learned that as an intern in Townsville when back in the,

it was the old Townsville Hospital where interns were the ones running,

one intern had the whole ED responsibility and one intern managed the rest of

the hospital at night duty. Um,

those were the days where we learned our medicine. But you know,

the nursing staff helped me survive my internship without too many

scars.

And it's that it's not the experienced doctor,

it's an experienced clinician and it's that accepting that the,

you know, when you're talking about experienced clinician on here,

I'm assuming you're not just confining that to a medical officer.

'cause there's some nurses on my peds ward there,

there's a couple of nurses that at times will bypass the registrar and ring me

and I will, you know, if it's three in the morning, I will get out of bed.

'cause they say they're worried about the kid. That makes me worried. Um,

No, I think you're beautifully enumerated. And this is something we, we,

we've gone back in the terminology. So I think this is more a, um,

space issue, but clinician is the word that is,

that clearly describes the person who makes that decision whether they're in the

pink box. And

I, I've worked rural and remote. The, uh,

I was the flying pediatrician out west. And I know in,

you've got some areas in our isolated areas

where it is a nurse.

And thanks to our wonderful country leaving for second year doctors

out of our big tertiary hospitals, um, we have a big problem. We,

we've got doctors go out with no pediatric exp experience,

well limited pediatric experience. And, um,

they really need to, you know,

man use telehealth and listen to the local nurses.

'cause a lot of them have been there for decades and they'll know more than you.

Um, and I just wanna also highlight what Emma mentions on the chat.

R S Q can provide cynical clinical review. Exactly.

So the R S Q phone call with R S Q either comes to us

as the pediatric medical coordinators for the state,

and we can link up not only by the phone or also, um,

video conference calls if in instances where there isn't a senior

clinician locally available queue. Uh, so this, this was,

this is actually, um,

a question someone asked me recently on a phone call, um, retrieval phone call.

Um, and I was like, oh, I'm not sure. I don't know what to do here.

So I thought I'll put this up and ask for suggestions from everyone. So, um,

and I, I do have a, a a way I practice,

but that practice changes depending on whether I'm practicing in, uh,

tertiary set up with, as you say, all bells and whistles. I can, um,

ask for help and I have 15 people in the room. So in those instances,

I would absolutely do a full septic screen including, uh,

lumbar puncture and urine culture. But preferably, even in those instances,

I wouldn't delay antibiotics if it was taking, uh,

more than what would be expected. So let's say half an hour or so,

I should expect that all the cultures and things are done and then antibiotics

are given. That said, even in the tertiary setup, if the patient is sick,

if the child is looking sick, I wouldn't delay.

That's the second point this.

So first I wanna separate this out into three different scenarios.

One is the tertiary setup where everyone's around. Um,

and the second would be perhaps slightly maybe suburban kaul kind of

a setup. And then maybe we can talk about the rural setup.

So tertiary is set up, yes, if the child is reasonably okay looking,

do all the cultures and then do antibiotics. If the child is sick, go ahead,

give that antibiotic. And then when you put the cannula,

you would've done the blood culture anyway. Don't wait for the urine and lp,

just give the antibiotics and then go ahead and do the LP when you think it's

appropriate.

The instance when I feel fairly uncomfortable doing lumbar puncture is when I

feel the neurology is something I cannot quantify well.

So the child is slightly abend. Parents say she's more sleepy than usual,

or she's not as responsive as usual.

You don't know whether this is septic and phalopathy or meningitis. Um,

and in that instance,

sticking a needle in the back makes me feel twitchy. Uh,

my clinician ID specialist, Adam, one of our colleagues,

we have this banter always where they say, have you done an lp? And I say, no,

I'm not gonna do LP today. Uh,

so we have this discussion because you could differ the lp,

you could look at the white cell count later,

and you could even do a P C R off the C S F or a 16 s if you happen to have

that resource.

And so you can define what that infection is,

bacterial or viral, even post-talk after the antibiotics have been given.

'cause the classic, uh,

defense for doing the LP before antibiotics is to say, oh,

if you give antibiotic, if it's a sensitive bug, you'll clear it,

you will not pick it up. Um, oh, I have said something,

a microbiologist is online, so I'm gonna just be careful what I say from here.

But feel free to come in and comment. Uh, please Michael. Uh, let,

so my thoughts are, yes, you should do it when you can,

but if you have a neurological worry, perhaps defer it, um,

until you're fairly comfortable. Um, for example,

we have had kids with decreased mental state where we thought, oh,

this could be seizures. And so I had delayed my LP on those instances.

So that was my tertiary, um, set up experience.

And I'm just checking that I haven't said anything, um,

totally out of keeping to what my Michael is saying. Michael,

free free to come in if you want.

Hi, sorry, I didn't wanna get crash the discussion. I'm, I agree with you.

Basically, I, so I've worked in emergency as well as, uh,

now I'm the director of microbiology at Central, at Royal Brisbane.

So our advice is always exactly as you said,

if there's gonna be any delay because just to collect specimens,

you should rather give the antibiotics and then, you know, shoot first,

ask questions later.

Because there's no point in having a great specimen and dead patient.

The priority is patient care,

and the quicker you get the antibiotics into a septic patient,

the higher the likelihood they survive. So if you,

what I've always done in emergency when I worked in emergency was that as we

cannulated withdrew the specimens and the person was drawing up the antibiotics

at the same time, and if they get their first patient gets the antibiotics, the,

um, a lot of the time you can still make a diagnosis, uh,

even if the person's had antibiotics.

What you can't sometimes do is grow the bacteria. So, um, you know,

that limits you in some ways you might not be able to tell that susceptibility

to antibiotics, but you can still make a diagnosis, an appropriate diagnosis.

Um, and especially if it's viral, uh,

the antibiotics make no difference to the diagnostic process.

We have a lot of P C R tests,

which can diagnose infections even when the bacteria are dead,

as long as the specimens collected quite soon after the antibiotics are given.

Um, so you can still at least get a diagnosis.

And through genetic sequencing of those P C R products,

we can often identify things like the serotype of, of, you know, uh,

mening of no meningitis or, uh, something like that. So, um, I would,

my advice is never hesitate to give the antibiotics quickly in a septic patient.

Thanks. Thanks, Michael. I'm glad I haven't, uh, said something which is, uh,

travesty. I do remember a discussion we had with Keith, um,

professor Keith mc Grimwood, right? Grimwood, um, Griffith University.

And he, he was saying around, I'm paraphrasing,

so please don't quote me on this, but he was saying,

don't forget to complete the septic screen. So you've had the patient,

you worried enough that you did the blood culture and gave the antibiotic,

but then remember to complete the cultures. Um,

because the clinician who's on the floor,

on the ward two days later now has to make a decision on whether to continue the

antibiotic, how long to continue and to change it or not,

based on half the information that they will have, because we chose,

we did not complete the screen.

So if it is possible after the initial resuscitation,

please remember to complete the whole set. Um,

so that would be tertiary ed setups and PQ setups. Um,

and then if you take that principle to the rural remote setup, um,

may I ask Lisa,

that principle that we just described should work in Caboolture too,

or sites similar to Caboolture.

That's how I practice. If they're, if they're septic,

you don't wanna put them into a fetal position to do a lumbar puncture, um,

res antibiotics resus then investigate. Um,

you know, it's, and it depends. It does, as you say,

depend it's resource driven because to do a cannulation and

to collect urine and to do lumbar punches,

if you are in a site where it might be the same person who's having to do

all of those, um, you know,

cannulate and do the lumbar puncture and potentially do the in-out catheter for

a urine, um, you,

you've gotta prioritize the iv the eye antibiotics and the fluids

above the others.

What we generally try and do is get the first urine that comes out,

and then if it's in the middle of the night and we resource poor, um,

we'll defer the lumbar puncture. And, and as Michael said, PCRs,

I, I trained before PCRs. And so we used to, it used to be the mantra,

get the lumbar puncture done before you give the antibiotics. Um,

so we got very, very good at doing lumbar puncture very quickly and slickly,

but that was in, again, in a tertiary pediatric setting. Um,

I think it does, PCRs do have their limitations,

but, um, I really like Michael's comment, the, um,

it's better alive patient than live bacteria in a dead patient.

So, and then to bring it further out to the rural remote setups,

there are two things to think about here as, as I take these calls.

One is,

do we have local expertise to place an IV line that comes

up across sometimes? And if that is possible,

we always would suggest that,

let's do that so that we get the collect culture and then give the antibiotic.

And we would definitely defer the urine and LP in those setups.

Uh, but occasionally there isn't, um, the expertise available.

And so here in, uh, we make a decision with the clinician,

we say, how long is it gonna take for us to move this child to a place,

for example, from Darling Downs further out to Toumba? Um,

we would say, if the child comes to Toowoomba, it's gonna take us three hours.

Is the child stable enough,

the pediatrician in TOUMBA is able to do the peripheral line cultures and

antibiotics, or do we then, or do we say the child looks unwell,

the ops look a bit off,

let's give an IM antibiotic and then move them

to get their further management as one would, uh,

like the ideal, so to speak. Um, but that's,

that's a scenario that unfortunately we are bound by what is available locally.

Um, and therefore I think we would go for that. If, however,

the patient is in shock,

they do not have enough perfusion through their muscles.

And so in those instances,

you're actually gonna put an IO and give antibiotics through the io.

So just to clarify that, and that's also what we have said in our pathway,

and we actually had a discussion within our team around this specific point

earlier this month. So that's how we have come to, um,

crystallize our thoughts around that. Uh, anyone from rural remote,

I saw a few people from Toro scape also online.

Yeah. Hi, it, Annette from Torres Strait. Can you hear me?

Yes, please continue. Please

Continue. Yeah. Yeah. Um, a majority of the, um,

health facilities up here in the Torres Strait are single nurse posts.

So we're majority of the positions as I hold as a C N C

and 40 years experience, um, that we usually,

that's part of our requisite that we should be able to cannulate children and,

um, because, you know, we, depending specifically on duan, we can,

we don't have an airstrip, so you can only get here by chopper.

So our retrieval comes from CNS or ti.

So it's really imperative that we, uh,

it's been very interesting going through this with the, um,

sepsis is the fact that if we have any concerns,

we've gotta move on it really quick or should I say,

I have to move on it really quick because time is of essence.

And of course when you were saying about collecting, we do have an I stat,

so we're quite, um, lucky with that. But things like urine specimens,

as you mentioned,

we don't have the time to wait for that if that's not available to, um,

commence IV antibiotics, um,

especially if there is a delay due to weather or whatever. So yeah,

so most of the,

the nurses up here in the Torres Strait that are on the single nurse posts do

know how to cannulate and of course put into osseous in if required. Thank you.

I'm finding this extremely interesting. Thank you very much.

Oh, thank you. No, I think I, I just also wanted to, um,

wanted your opinion on the comments I made around how we manage these children,

um, because of course, my view is from centralized in Brisbane,

so I do want a feel for what we think is happening in the,

in the rural remote setups is what is actually happening. So when,

uh, when we don't get that IV line,

you would migrate to if the if has shock,

then IO or otherwise I am Is that how you manage?

Yeah, that's in, correct. Yeah. So if there was,

and I've had considerations in at times working in the territory where I had a

child that was quite flat and ended up meningococcal,

but I'd given the I I M I capaxone. So yes, that is an option of course. Yeah.

Brilliant. Yeah.

Um,

so the barrier that we often hear at the moment,

um, in the last few months is we're using the pathway less and less.

So how do we actually make it sustainable? Um,

so

the key points I just wanna highlight here, I suppose is,

is understanding why, um, doing some in investigations, I suppose,

in what those, what the reasons might be, um,

that it has maybe fallen on the wayside or, or has, has become, um,

not business as usual. People are not picking up the pathway. Um,

so some of those reasons that we, that we hear from sites, um,

and that we know of is obviously, you know,

a changing workforce and a constant turnover of staff does provide challenges.

There's competing priorities, um, project fatigue, you know,

there's a lot of quality improvement projects, not just sepsis. And so there is,

um, pressures on our clinicians, um, for that cognitive load,

and all of those are really valid. So I suppose my point is to, to understand,

um, why and to do some investigations, um, listen to your staff understand,

um, if they know the pathway exists. Is it, is it in, uh,

difficult to reach area?

I'm not sure having a conversation with those people on the floor on why, um,

that it may not be picked up as often as it was, um,

from our point of view. Um, and from our experience,

we've developed some resources, I suppose, to, um,

guide you or help you to sustain the pathway. Um,

we know that there's an incredible amount of work that goes into, um,

launching and implementing the pathway, um, and then less,

less so in in sustaining it. Um, so what we've done is, um,

we've developed this implementation framework and toolkit, uh,

and the toolkit I did speak to, uh, in the October seminar series, um,

which Sarah will post in the chat a link to that video if you did wanna watch

it. Um, but basically the toolkit is, um, a,

a multitude of resources that will help you, um,

and some advice and guidance in terms of, of helping you.

And so the one things I wanted to highlight today was really, um,

probably the first bit in the sustained, um,

step is measuring change in your practice and evaluating the outcome. So,

um, as part of this, I think the,

the number one thing is data collection.

We know it's really labor intensive to collect data, um,

but if you don't have that evidence or don't have that understanding, um,

it's hard to, to show any improvement or to, to kind of involve, um,

the staff and clinicians in understanding, um, um, the benchmark and, and,

and how you are improving. So my first point would be, um,

being able to measure the change and being able to collect data,

even if it's just on one key measure. So, um, within our toolkit,

we have a data collection pro performer, and we also, uh,

put a picture in here of the, um, new South Wales performer as well. Um,

there's obviously a number of process and, um, outcome measures and, um,

balancing measures,

but if you're finding it difficult or it seems too overwhelming, um,

in terms of the, the, the intensity of collecting that data, I,

I strongly encourage you just to, just to focus on one key measure. So, um,

perhaps just for the next month, focusing on, um,

time to antibiotics so that in a month's time you've got some data,

you can use that as a conversation starter with the teams in your huddles. Uh,

and then in another month's time you can, you can measure it again. Um,

we encourage you, there's real power, I suppose,

in using that as a conversation starter or sharing stories.

So sharing the wins that you have made, uh, making, making it real and keeping,

um,

the pathway as part of your conversations within your huddles and your groups so

that it stays there at the forefront of your mind, um,

and embedding it obviously into business as usual. So, um,

another idea would be, um, I know that some sites,

I'm not sure if we have Rocky online, but Rocky have, um, obviously have a,

they've done up a, a registered nurse professional, um,

development pathway or specific training matrix.

And so as part of those ongoing education,

it's part of their framework and it's part of their, um,

matrix that their staff have to do optimist, prime or optimist bonus on a,

on an annual basis. Um, and so therefore it's, it's embedding it, um,

and keeping that awareness for, um,

new staff or for that cha changeover of staff. Um, it's also, as I said,

embedding it into business as usual.

So thinking about what kind of groups currently exist at your site, um,

we obviously, you know, um, there's real value in having champions, uh,

lead these quality improvement activities, but we, um,

understand there might be, um, you know,

pediatric working groups or there might be close ops meetings or standard eight

meetings. So you could certainly ask to have, um,

pediatric sepsis as an ongoing agenda item on those particular groups that

already exist. So therefore, um, they are embedded in part of your,

your standard processes and groups already. Um, there's also,

I've just put a link in there too, to the, um, uh, n h S sustainability guide.

There's some actually really great practical tools and performers and,

and tips and stuff in there as well. And that is linked into our toolkit.

So if you go onto our website and our toolkit, um, the link is there below. Um,

we do link in the, the sustainability guide. So there's some actual practical,

tangible resources that you can use there as well.

Um, the second barrier that we hear, um,

from across the state, and this is certainly comes up, um,

time and time again from,

from the site visits that I've done and the conversations that I've had with

clinicians over the last couple of years. Um,

it sepsis awareness and knowledge is low at my site. How do I raise awareness?

Um,

so we obviously have a

multitude of resources already, and so my advice is, um,

adapt these for your site. There's no need to reinvent the wheel. There's,

there's, there's all of these incredible resources to help you raise awareness.

And there's,

there's specific resources targeted to health professionals and clinicians,

um, like lanyards or, um, posters.

And then there's also a multitude of resources targeting families as well. So,

um, Kate spoke before about, um, uh,

our resources for culturally and language linguistically diverse families in our

Aboriginal Torres Strait Islander families,

and we've got family support network brochures. Um,

so I think the more visual aids that you have,

people are reminded of pediatric sepsis. Um,

we also work with the pro ed team,

so we have rotating slides available to you, um,

that can be flashed up on your digital TV screen. So once again, there's,

there's some, there's some imaging and a constant reminder and, um, to,

to help raise awareness about sepsis. Uh,

obviously our website has posters, um, key messages. Um,

I'm sure most of you have seen the website by now,

but we are constantly updating that with resources, uh, and,

and education as well. So I certainly encourage you to have a look at that.

Um, and I know of,

I suppose thinking about, um, what other sites may have done.

We talk about the resources we've developed in terms of raising awareness. Um,

I know that I think Kathy is online. Um, Kathy Mans,

the patient safety at C N C at Toowoomba, um, has developed, um,

a specific standard eight page on their quips.

So once again, there's just a, the one-stop shop, uh, with resources and,

and sepsis bulletins and stuff that I think, uh,

is tailored specifically to your local sites and where local clinicians would

access information. So, not sure, Kathy,

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.