Conan Gasque (Host): Welcome to Inside Pediatrics, a podcast brought to you by Children's Hospital of Alabama in Birmingham. I'm Conan Gasque. Thanks so much for joining us today. We're talking about the topic of sepsis and we're joined by a sepsis expert here at Children's of Alabama, Judy Fuller, a registered nurse here at Children's. Again, sepsis, our topic. I want to start, Judy, by talking a little bit about sepsis and what exactly sepsis is. How would you explain that to a parent who's maybe not familiar with it?

Judy Fuller, RN: So, sepsis is an overwhelming infection that happens in the body. It usually happens after a previous infection. So, kid has an ear infection, kid's had pneumonia, the flu, and then the body just takes over with an overwhelming infection, which turns into sepsis. Sepsis can cause tissue and organ failure or even death. So, that's why it's important, with children, to make sure that we catch it early. And by doing that, we tell parents the things to look for. A lot of symptoms of sepsis mimic other illnesses. But we tell parents those symptoms that just keep on for longer than normal.

So, some of the symptoms that we tell parents to look for would be fever, any kind of like patchy rash that you touch and it doesn't go away; increased breathing, they're breathing faster; a heart rate that's really rapid, that stays rapid for a long time, even when the fever's gone. So, all of those are important things to tell parents to look for.

Host: So if a parent sees that in their child, what should they do?

Judy Fuller, RN: They should act quickly. They need to either take them to their local pediatrician or bring them to the emergency department.

Host: Is sepsis something that's sort of hard to identify, I guess, because the symptoms can mimic those initial symptoms.

Judy Fuller, RN: Yes, absolutely. That's the thing. And that's why we talk about the rapid heart rate and the rapid respiratory rate. Yes, you see those when kids have fever, but they're going to be ongoing even when you've given fever reducer. And the temperature has gone down, you're still going to see that rapid heart rate and rapid respiratory rate, which kind of keys us into, "Okay, hey, maybe this is something more than, you know, just the flu or a simple virus."

Host: How does sepsis in a child compare to sepsis in an adult? Is it especially difficult for a child?

Judy Fuller, RN: It is. It is. So, in the adult population, you know, they kind of decompensate quicker. In pediatrics, in children, they can compensate for a long time, just because that's the way their bodies are. They're younger, so their body can compensate a lot longer and you won't notice the symptoms because their body's just compensating for it. And then when it doesn't, then we're kind of in trouble.

Host: And I know, one of the reasons we brought you on this podcast is because you are an expert in the area of sepsis. You play a very important role here at Children's. But you also have a personal story about sepsis. Can you share with us what that is?

Judy Fuller, RN: So, 24 years ago, 25 years ago, I wasn't a nurse then, but I was a mother of a 7-year-old who was battling cancer. And we visited our local emergency department quite frequently, but this time the fever would be different. He passed away and I later found out that it was from a complication due to sepsis. So, that was basically the catalyst that led me to change my career and go to nursing school. And I actually work in that same department that treated my child all those years ago.

Host: What does it mean to you now, all these years later, to be able to help out parents who may be going through the same thing that you went through.

Judy Fuller, RN: It's amazing. You know, back then, that was a long time ago, sepsis wasn't a thing, or it was, but we didn't know as much about it and we didn't have the precautions that we have now. So, to be able to give those families and give back, it's great to see the lives that we save that once couldn't be saved.

Host: And you were inspired by your situation to make a difference and really move things forward and find new ways to help these patients.

Judy Fuller, RN: Right. And that's why we'll lead into like why I do the committees I do and why I do the things in the emergency department I do so that I can make a difference in these patients.

Host: Tell me about some of the committees that you're on.

Judy Fuller, RN: Okay. So, the biggest one to me is called the IPSO Sepsis Committee and that basically stands for Improving Pediatric Sepsis Outcomes. And what that means is it's a collaborative of about 60 hospitals nationwide. And so, what we do is we work through things to improve sepsis mortality rates, and that we meet once a month, usually via Zoom due to COVID. And we talk about did we meet our goals, what can we do to improve and so forth. Also as a part of that, I do chart reviews every month on all the patients in the emergency department that met sepsis, or even the ones maybe that should have, but didn't and I review those charts so that I can get with the nurses and say, "Hey, what a great job you did," or sometimes we have to improve things to make our patient outcomes better.

Host: So, you're really in a position where you can make a difference in the way that sepsis is handled and prevented here at Children's as a whole.

Judy Fuller, RN: Absolutely. So on the part of the collaborative, we make changes to the protocols that we may need to change or do. And we look at other hospitals at what they're doing. And it all comes together into that we're all doing the same thing and all meeting the same goals. But then, in the emergency department, I am the sepsis champion down there. So, I educate new nurses on what to look for because sepsis is not just about your vital signs, but it's also about what does the patient look like and what is their history? How long have they had fever? Are they what we call high risk, which is do they have cancer? Have they had a transplant? All of those things factor into how risky it is for them to get sepsis. So with that, orienting the new people plus the old people sometimes need a refresher on, you know, looking at my vital signs, looking at what my patient looks like as soon as they come in the door, and then putting that all together and teaching them the right way to look for sepsis.

Host: And it's important for nurses to have that education because they play such a crucial role in dealing with sepsis.

Judy Fuller, RN: Absolutely. So, nurses, for the emergency department, as soon as the patient walks in the door, that's the first person they see. So being able to look at that patient and say, "Okay, this kid's here for fever," and he doesn't look so good. And then, we look at them, get vital signs, and then the combination of the two would trigger the patient's sepsis. But once they get to the back as well, that's the person that the nurses see most often. Even when they move upstairs, they see the nurse the most often. So when something changes with the patient, the nurse is going to be the first person to see that and recognize that this patient has turned into sepsis. So then, their role would be to notify the physician and let's get things started on that end.

Host: Very important role that nurses play in general, and I know you play a specifically important role in addition to that here at Children's, including a device that we used here that you introduced at Children's. Tell me about that.

Judy Fuller, RN: Yes. So back around 2017 or '18, I was the person that was able to go to the ENA Conference, which is a big nursing conference where they have a lot of vendors, a lot of different products to look at, to see if you would like to introduce them at your hospital. So, there was a device, it's a handheld rapid infuser. It's called a LifeFlow. And it basically helps with rapid fluid resuscitation in patients. So, brought it back here. We introduced it in the emergency department, I think, in 2019. We actually have added it to part of our sepsis bundle if it's able to be used for that patient. And we also introduced it to the hospital wide and put it in all of the crash carts, I think, in 2020.

So, this device has helped tremendously meet our fluid resuscitation goals. It also has helped improve our hospital-acquired infections. Whereas with the push-pull method, it kind of replaces that method of giving fluids. So, it helps reduce those hospital-acquired infections that you would get from the push-pull method.

Host: What's it like for you to know that you've had that kind of an impact, you're bringing in new technology?

Judy Fuller, RN: Oh, it's great because literally with this device, you know, your kid, you'll start giving the rapid fluids and you can immediately see a change in the way they're acting and in their vital signs, their heart rate comes down, they start to look better. And it's just a great feeling to know that I've done something to improve, you know, these patients' outcomes.

Host: We've talked a little bit about the different things that we do to prevent sepsis here and how we treat it. Anything else you want to add about what we're doing here at Children's to handle sepsis in general?

Judy Fuller, RN: Yeah. So, I want to talk a little bit about our sepsis pathway and what happens when a patient does trigger sepsis. And again, this is the nurse that does most of these things in this. It's a five-step thing that we do. So it's the sepsis tool, which is the sepsis screening that's done as soon as they get here. And then, you have your sepsis huddle, which means you meet with the doctors and the whole collaborative team in wherever the patient has triggered sepsis and decide, "Okay. Yes, this patient's probably sepsis "or No, they're not," continue or discontinue the pathway. And then, you have your sepsis order set that we have worked really hard on to make sure that the doctors know exactly what they need to order for this patient.

And then, the first thing is time to fluid resuscitation, which is 20 minutes from time of trigger. And then the last thing, the most important thing, is antibiotics within an hour of the time of trigger. And again, the only thing that's really out of the nurse's scope would be the doctor's order set. So again, the nurses are responsible for getting the IV started, getting fluids started, getting the antibiotics started, making sure the sepsis huddle is done. So, again, another reason that the nurses are crucial in this. So, having all of those tools to be able to get that done for the patient is, I think, extremely important. And what makes sepsis, you know, decrease those mortality rates in sepsis.

Host: So if a child gets sepsis, there's a very specific detailed process that we go through here to deal with it.

Judy Fuller, RN: Absolutely, yeah.

Host: What would your message be? You've been through this as a parent, you've been through it as a medical professional. If a parent has a child who develops sepsis, what is your message to them about what do they need to know?

Judy Fuller, RN: The biggest things to look for is just act quickly. Like if your child has been sick for over a week, you know, greater than five days with fever, you may need to seek some care and see what else is going on besides that simple virus. Because we usually tell parents after five days, it may be a little more concerning, it may not be. And also just, you know, we teach nurses and parents handwashing. Handwashing is a big prevention of all viruses and can be for sepsis. Also vaccines, the importance of getting vaccines is very important. And then lastly, I just can't stress enough to act quickly when you're seeing those symptoms that are just not going away.

Host: Very good information for parents about the topic of sepsis. Once again, Judy Fuller, registered nurse here at Children's of Alabama. Judy, thanks so much for your time. Thank you.

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