None listed
Conditions
Brief summary
This research will examine the impact of implementing a point of care (PoC) lactate machine on the administration of antibiotics in paediatric patients presenting with potential sepsis in the Emergency Department (ED). Elevated lactate levels are proven to be an accurate prognostic factor in predicting morbidity among patients with sepsis. Current practice requires that serum lactate samples are collected via intravenous cannulation or venepuncture, a distressing procedure for children and parents and challenging and time-consuming for staff . The PoC lactate machine is a portable, single-operator handheld device requiring finger prick blood sampling to obtain accurate lactate results. This negates the need for intravenous cannulation or venepuncture to obtain objective data to aid clinical decision-making. This may result in the earlier recognition of sepsis, administration of antibiotics and transfer to definitive care.
Interventions
The study will utilise fingerpick testing to obtain a blood sample (<0.6 microliters) from paediatric patients to conduct a Point of Care (PoC) lactate test. Lactate results are returned within 13 seconds, and documented within their medical record.
The PoC Lactate machine chosen is the NovaBiomedical Lactate Xpress Stat Strip Point of Care connectivity machine. It is a portable, single-operator handheld device requiring a whole blood sample of 0.6 microlitres to obtain a lactate result with
The study will utilise fingerpick testing to obtain a blood sample (<0.6 microliters) from paediatric patients to conduct a Point of Care (PoC) lactate test. Lactate results are returned within 13 seconds, and documented within their medical record. The PoC Lactate machine chosen is the NovaBiomedical Lactate Xpress Stat Strip Point of Care connectivity machine. It is a portable, single-operator handheld device requiring a whole blood sample of 0.6 microlitres to obtain a lactate result within 13 seconds, The machine is calibrated to return a lactate result from 0.3-20.0 mmol/L. These machines are presently endorsed by Queensland Health for use within other health care services throughout Queensland. The test will be conducted by both registered nursing and medical clinicians from child participants who meet the screening eligibility criteria detailed on the Queensland Children’s Sepsis Pathway (QCSP) which is currently part of standard care. Children can be screened at any point during the patients journey (not just at Triage) within the Emergency Department (ED) with testing to occur when patients meet the outlined criteria. Upon returning a elevated lactate results (of >2mmol), Clinican’s will follow the QCSP to escalate care to the Senior Medical Officer (SMO) or Senior Registrar (SR) on shift for immediate review of the patient. Ongoing treatment will be at the discretion of the treating medical officer and will not be dictated by the PoC lactate result. Phase One, Pre Intervention Cohort - Involves a medical chart audit of eligible participants admitted to Redcliffe Hospital during November 2023 - January 2024,. Phase Two, Education and Consolidation - Involves a 3 month staff education (February 2024 - April 2024) on the PoC Lactate device and two month consolidation period (May 2024 - June 2024) of when the device will be utilised but patients will not be recruited into the study for analysis. This is to ensure that staff are confident in when and how to use the machine and to ascertain the independent influence of the machine’s integration into standard care, allowing for observation of the true impact of the intervention. Phase Three - Post Intervention Group - Involves the prospective recruitment of participants for the implementation and use of the PoC Lactate machine over a three month period (July 2024 - September 2024) and data collection.
Sponsors
Redcliffe Hospital (Redcliffe Private Practice Trust)
Study design
Allocation
Non-randomised trial
Intervention model
Single group
Primary purpose
Diagnosis
Masking
Blinded (masking used) (Investigator)
Eligibility
Sex/Gender
All
Age
1 Hours to 17 Years
Healthy volunteers
No
Inclusion criteria
To be eligible for the study, parent-child dyads must meet the following criteria. Patients need to be 17 years of age or younger with signs of an infective/viral illness and meet screening criteria for potential sepsis as outlined on the QCSP. These include: Signs of infection, inclusive of history or evidence of fever or hypothermia, in addition to (a) Looks sick/toxic (b) Altered behaviour or altered level of consciousness (ALOC), defined by progressive lethargy, drowsiness or obtundation, restlessness and/or agitation and irritability/apnoeas in infants. (c) Parental/guardian/clinician concern (d) Re-presentation with the same illness (e) Sepsis admission <30 days (f) Aboriginal or Torres Strait Islander (g) Immunocompromised (h) Age <3 months
Exclusion criteria
Patients will be excluded from participation if: (a) They present with altered Children’s Early Warning Tool scores due to trauma. (b) They present with ALOC attributable to trauma. (c) If consenting parents/guardians cannot read, write and/or understand English.
Outcome results
None listed