Positive Reporting and Appreciative Inquiry in Sepsis (PRAISe)

Sepsis is a leading cause of death in children. It is an abnormal response to infection that needs to be recognised early and treated promptly with the correct antibiotic.

Antibiotic stewardship is the processes of ensuring antibiotics are used safely and appropriately in order to reduce antibiotic resistance. This involves selecting the correct antibiotic at the start of treatment and de-escalating treatment as soon as possible.

This project from Birmingham Children’s Hospital aimed to improve early sepsis management and antimicrobial stewardship in paediatric intensive care unit (PICU) patients, and reduce antibiotic consumption by 5%.

It involved using an innovative intervention adapted from the Learning from Excellence (LfE) initiative. Four key process measures were identified, and excellence in these processes was identified and reported through LfE, providing formal positive feedback to clinicians. Selected reports were followed up with ‘appreciative inquiry’ interviews. Insights gained were shared to generate change across the wider team.

Following the intervention, use of antibiotics decreased by 6.5% from the equivalent period the previous year. There was also a 31% improvement in broad-spectrum antibiotic use.

There have been significant improvements in some processes, including gold-standard prescribing and antibiotic review. However, minimal improvements were made in other processes such as documentation of the decision to treat. The team found that the LfE interventions are more effective in smaller groups of staff, to reinforce activities that occur frequently.  

The project will continue beyond the funding period, but on a smaller scale within the PICU. The project has already started to expand outside the PICU.

Contact information

For more information about this project, please contact Dr Adrian Plunkett, Consultant Paediatric Intensivist, Birmingham Children's Hospital.