(1053) Feasibility of a Time-Limited Sepsis Rule-Out Order Set in a High-Acuity PICU

Introduction: Sepsis is one of the major causes of mortality and morbidity in the pediatric population. Ideally antibiotic delivery should be delivered within one hour for septic shock and within three hours for severe sepsis identification to reduce the increased risk of mortality. Current Surviving Sepsis guidelines recommend narrowing or de-escalation of empiric antibiotics if no pathogen is identified. At Children’s Healthcare of Atlanta (CHOA), time to positivity in 95-97% of blood cultures in our patient population is around 36-48 hours. Antibiotics may be continued longer than this period despite negative cultures due to no de-escalation plan. Our project focuses on the creation and use of a time-limited sepsis rule-out order set within our Epic electronic health record at CHOA to evaluate the feasibility of automatic stop times for common empiric antibiotics after 36-48 hours of dosing in a high-acuity unit.

Methods: This quality improvement initiative began in early 2023 with the creation of a “PICU Sepsis Rule-Out” order set. This order set includes common cultures and antibiotics ordered with appropriate dosing and stop times validated by CHOA PICU pharmacists and antibiotic stewardship team. After positive response during usability testing, this order set was presented to the PICU division and released in October 2023.

Results: This order set has been used 122 times with 102 unique patient encounters over the course of nine months with steady increase since introduction. 71 patients were identified to have antibiotics ordered from the order-set. In this population, 21 (29.6%) patients had antibiotics changed or discontinued prior to scheduled stop time and 44 patients (62%) had antibiotics stopped appropriately with negative blood culture. 6 patients (8.4%) had antibiotics discontinued prematurely due to stop time with an average of 14 hours in delay in receiving their next dose.

Conclusions: Introduction of a curated critical care sepsis order set can be helpful in appropriate shortening of antibiotics but must be carefully reviewed to avoid premature termination of therapy. Currently, a user feedback survey is being evaluated to determine factors that could improve ease of use and build provider trust in the time-limited order set to avoid inappropriate discontinuation.