1) Appropriate use of stress dose steroids
2) Provide protocol print outs on Pediatric ICU Unit
3) Identification of indications for administration stress dose steroids and duration of treatment
4) Appropriate steroid regimen disposition
AIMS: It is well known through previous literature and case reports patients with known adrenal insufficiency, patients on chronic corticosteroid therapy >14 days require stress dose hydrocortisone therapy in a critical care setting to remain hemodynamically stable. We wanted to apply standardized guidelines for the latter patient presentations along with a protocol-based approach to pediatric patients in a critical care setting with risk factors including catecholamine-resistant shock requiring greater than 60 cc/kg fluid bolus and requirement of 2 pressors along with patients with potentially unknown adrenal insufficiency presenting with symptoms of adrenal crisis including but not limited to hypotension, decreased alertness, hyponatremia/hyperkalemia/hypoglycemia.
Intervention: PDSA Cycle 1: Initial stress dose Hydrocortone pathway presented to Dr. Anjali Subbaswamy, Pediatric Critical Care and Dr. Michelle Hutchison, Pediatric Endocrinology. My goal was to identify precise and clear risk factors for practitioners in the inpatient setting, along with provide initial laboratory orders and symptomatic parameters raising alarm for concern.
PDA Cycle 2: Further recommendations from expert team above and my application further scaling down diagnostic approach to scope around Pediatric Critical Care patients and classification of severity of symptoms. Currently working on PDA Cycle 3.
Grammens, Ryan; Michele Hutchison; and Anjali Subbaswamy. "Standardization of Stress Dose Hydrocortisone in the PICU: A Quality Improvement Project." (2023). https://digitalrepository.unm.edu/hsc_qips/88