Evaluating the current state of sepsis in your facility 7 ... · ©Sepsissolutionsinternational LLC 2018 Evaluating the Current State of Sepsis in Your Facility Pat Posa RN, BSN,

FOUNDING SPONSOR

Evaluating the Current State of Sepsis in Your Facility

Founding Sponsor Network Sponsors

Pat Posa, RN, BSN, MSA, CCRN-K, FAAN Quality Excellence LeaderSt. Joseph Mercy HospitalAnn Arbor, Michigan

Angela Craig, APN,MS,CCNSICU Clinical Nurse SpecialistCookeville Regional Medical CenterCookeville, TN

©Sepsissolutionsinternational LLC 2018

Evaluating the Current State of Sepsis in Your Facility

Pat Posa RN, BSN, MSA, CCRN-K, FAANQuality Excellence LeaderSt. Joseph Mercy Hospital

Ann Arbor, [email protected]

Sepsis Solutions International LLC

Angela Craig APN, MS, CCNSClinical Nurse Specialist

Critical CareCookeville Regional Medical

CenterCookeville, TN

[email protected]

mailto:[email protected]

Disclosures

Pat PosaAngela Craig

• Nurse Consultant with Edwards Lifesciences.

• Speaker Bureau: ELS• Consultant for Tennessee

Hospital Association

• Consultant-Michigan Hospital Association Keystone Center

• Consultant-HRET Hospital Improvement Innovation Network (HIIN)

Overview-Objectives

1. Summarize the four-tier process for effective sepsis program development, implementation and evaluation

2. Examine the evidence for the sepsis bundles and share proven strategies to resolve barriers in implementation and measurement of core measures

3. Identify gaps between the evidence and your hospital’s sepsis program

Sepsis Gap Analysis and Action Steps

1

Sepsis Gap Analysis and Action Steps

COMPONENTS

YES

NO

NA

Action Steps Organizational Commitment/ Team

Physician and nursing leadership participate in action planning for sepsis initiatives

Multidisciplinary team in place and monthly meetings (providers, nursing, quality, care management, etc)from various care areas, ED, ICU, Med Surg, Perinatal, peds

Executive sponsor receives regular data reports and provides feedback

Sepsis Team is part of/ reports to Critical care or quality structure in hospital

.

Managing sepsis is aligned with hospital’s quality, safety or organizational goals

Baseline data collection completed for process and outcome data

Dedicated Sepsis resource/ Sepsis Coordinator Dedicated Sepsis Resource in place (in comments identify title)

FTE allocation/ time commitment to sepsis role Site/ sites supported Other responsibilities in the role

Identification/ Screening Early alert or warning system/process in place in the ED or describe triggers for sepsis screening:

ED ICU INPATIENT UNITS PERINATAL PEDIATRICS Is a screening process completed consistently as designed?

All ED patients are screened/ assessed for sepsis in triage?

All ICU patients are screened/ assessed for sepsis upon admission and every shift – describe process

All med surg patients are screened/ assessed for sepsis upon admission and every shift – describe process

All OB patients are screened/ assessed for

Sepsis is an Epidemic

• Affects >1 million Americans per year• 3rd leading cause of death in the US • Sepsis occurs in just 10% of U.S. hospital patients, but it

contributes to as many as half of all hospital deaths• US spends $24 billion per year to treat

6

Ø 700 people die each day from sepsis in the U.S.Ø Every 2 minutes someone dies of sepsis in U.S.

1.Sands KE, Bates DW, Lanken PN, et al. Epidemiology of sepsis syndrome in 8 academic medical centers. JAMA1997;278:234-40.2. National Vital Statistics Reports. 2005.3. Angus DC, Linde-Zwirble WT, Lidicker J, et al. Epidemiology

of severe sepsis in the United States: analysis of incidence, outcome and associated costs of care. Crit Care Med2001;29:1303-10.

4. AHRQ: accessed 06/27/2016 http://www.healthcarefinancenews.com/news/septicemia-newborn-care-top-list-most-expensive-treatments-agency-healthcare-research-and

5. Novosad SA, et al. MMWR, 2016;65L33):864-869

http://www.healthcarefinancenews.com/news/septicemia-newborn-care-top-list-most-expensive-treatments-agency-healthcare-research-and

Sepsis: CDC Vital Signs

• 80% of sepsis cases begin outside the hospital

• 7 in 10 patients with sepsis had recently used health services

• 4 most common types of infection in sepsis are lung, urinary tract, gut & skin

• Health Care Providers: Think Sepsis & Act Fast

https://www.cdc.gov/vitalsigns/sepsis/August 2016

Infection Prevention

VAE (VAP) Bundle

Organizational Consensus that Severe SepsisMust be Managed Early and Aggressively

Early Screening with Tools and Triggers

Implementation of the Sepsis Bundles

MeasuringSuccess

CQI1

Sepsis Practice Collaborative Model4 Tier Process for Program Implementation

CAUTI

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Documentation Improvement ~ Accurate Coding

1Continuous Quality ImprovementAdapted from: Sepsis Solutions International

Non-vent HAPCLABSI

Tier I: Organizational Consensus and Support Milestones and Checklist

1. Define Sepsis Program Goal and aligned with organizational goals

2. Identify Executive sponsor3. Collect Baseline Data—essential step4. Develop sepsis team(do we have all the right people

here?) and schedule monthly(minimum) meeting for at least 6 months

5. Identify nursing and physician champions in ED and ICU and ensure champions attend team meeting

– Create a sepsis coordinator position to oversee program6. Begin to define action plan and timeline for program

development and implementation

Impact of Sepsis Coordinator

HCA added sepsis coordinators to all facilities

(FTE was based upon sepsis volume)

– Severe sepsis/septic shock mortality dropped

from 22% to 15%

– Bundle compliance improved to 61%

– Other key elements initiated were order sets,

sepsis alerts, routine screening, sepsis

champions and community outreach

Presentation at Colorado Hospital association Sepsis ProgramThe role of nursing best practice champions in diffusing practice guidelines: a mixed methods study Worldviews EvidBased Nurs.2010 Dec;7(4):238-51. doi: 10.1111/j.1741-

6787.2010.00202.x. Epub2010 Sep 28.

Role of the Sepsis Coordinator

• Facilitates implementation/evaluation of the Sepsis program including all systems necessary for the multidisciplinary approach throughout the continuum of care.

• Makes regular rounds on sepsis patients to evaluate appropriateness of orders, treatment plans, nursing intervention, physician documentation and compliance with the Sepsis bundle

• Utilizes currently available reports to identify sepsis cases and facilitates data collection process and assesses and analyzes outcomes.

• Collaborates with frontline staff to identify on-going care concerns related to sepsis care

• Collaborates with leadership and colleagues in identifying sepsis quality of care issues

Role of the Sepsis Coordinator

• Determines baseline compliance with physician documentation and compliance with the Sepsis bundle.

• Provides real time/detailed feedback to all clinical providers and departments and scheduled updates to the Sepsis Collaborative Team and work groups.

• Assist the rapid response team and other hospital staff, when necessary, if dealing with a patient situation

• Conducts sepsis organizational tracers to identify quality and safety issues.

• Analyze data to identify trends and issues, also use improvement tools to assist with problem solving and action planning.

• Provides formal and informal education to medical and clinical staff.

• Maintains knowledge of current trends and developments in the sepsis management, fields of quality, and safety.

Infection PreventionVAE (VAP) Bundle BSI




MeasuringSuccess

CQI1


CAUTI

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Documentation Improvement ~ Accurate Coding 1Continuous Quality Improvement

Adapted from: Sepsis Solutions International

Tier II: Screening for Severe SepsisMilestones and Checklist

• Develop screening process for ED, rapid response team, ICU and house wide

• Develop audit process to evaluate compliance and effectiveness

• Ensure screening process has clear “next steps” defined for nursing staff

1. Dellinger RP, Levy MM, Carlet JM, et al. Surviving Sepsis Campaign: International guidelines for management of severe sepsisand septic shock: 2008. Crit Care Med. 2008;36:296-327.

2. Schorr C. et al Journal of Hospital Medicine, 2016;11:S32-S39

If you don’t screen you will miss patients that may have benefited from the interventions

PATIENT CAREUNIT SEVERE SEPSIS SCREENINGTOOL

Electronic Routine Screening





MeasuringSuccess

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Components of TIER IIIMilestones and checklist

• Understand current process for caring for septic shock patients

• ‘Go and See’ work• Baseline data

• Order sets• Common Barriers/Issues: identified Gaps from ‘Go and

See’ work• Educational plan• Implementation plan

• Unit champions• Prospective rounding• Independent checks

SEP-1

TO BE COMPLETED WITHIN 3 HOURS OF TIME OF PRESENTATION † :

1. Measure lactate level2. Obtain blood cultures prior to administration of

antibiotics3. Administer broad spectrum antibiotics4. Administer 30ml/kg crystalloid for hypotension or lactate

≥4mmol/L

† “time of presentation” is defined as the time of earliest chart annotation consistent with all elements severe sepsis or septic shock ascertained through chart review.

Time Zero

• Will always be when the chart annotation suggests signs and symptoms are all present.

• May be from nursing charting/screens, lab flow sheets, physician documentation, order sets, anything with a time stamp.

• Will = triage time if all signs and symptoms are present at triage.

• It does not require MD documentation of the clock starting and relying on this alone in the ED would likely result in late clock starts.

Slides courtesy of Sean Townsend

Sepsis coding is increasing but is accurate. More aggressive treatment seen from 2003 to 2013

Law A & Klompas M, Infect Control & Hosp Epid, 2015

TO BE COMPLETED WITHIN 6 HOURS OF TIME OF PRESENTATION:

5. Apply vasopressors (for hypotension that does not respond to initial fluid resuscitation) to maintain a mean arterial pressure (MAP) ≥65mmHg

6. In the event of persistent hypotension after initial fluid administration (MAP < 65 mm Hg) or if initial lactate was ≥4 mmol/L, re-assess volume status and tissue perfusion and document findings according to table 1.

7. Re-measure lactate if initial lactate elevated.

SEP-1

TABLE 1DOCUMENT REASSESSMENT OF VOLUME STATUS AND TISSUE

PERFUSION WITH:

Either • Repeat focused exam(after initial fluid resuscitation) by licensed

independent practitioner can including vital signs, cardiopulmonary, capillary refill, pulse and skin findings. Or document sepsis reassessment completed

Or one of the following(for core measure after July, 2018)• Measure CVP • Measure ScvO2• Bedside cardiovascular ultrasound• Dynamic assessment of fluid responsiveness with passive leg

raise or fluid challenge

SEP-1





MeasuringSuccess

CQI1


CAUTI

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Tier IV: MeasurementMilestones and Checklist

• Define outcome and process data elements that will be collected

• Develop and implement a data collection process• Revise and update goals and action plan as needed• Execute implementation plan• Continuous improvement

• Sepsis management is now a CMS core measure that started October 1st 2015

• Compliance is All or None—so all measure on the 3 and 6 hour bundles (that the patient qualifies for) need to be met in the

appropriate timeframe to be compliant

Public reporting begins July 2018 (based on 2017 Q1-3)

Data measurement and Use of data

How you Collect Data Impacts UseHow is Data Used Prospective Concurrent RetrospectiveAnticipatory review of patientrecord (can impact current care)

Yes No No

Data abstracted in real time or within 24 hours Yes No

Serves as a prompt to execute bundle or the next phase of the bundle

Yes Yes No

Recommended for new improvement teams Yes No

Recommended for advanced improvement teams or those that have demonstrated success with process measures

Yes Yes

26Surviving Sepsis Campaign, Society of Critical Care Medicine, website accessed 1/26/2017

What outcome and process data should be collected and reviewed?

• Understand your volume of sepsis, severe sepsis and septic shock—look at mortality, LOS, cost, readmission

• Stratify your data by:– POA, non-POA– Medical vs surgical– Discharge disposition– Sepsis severity

• Process Metrics– Overall SEP-1 compliance– 3 hour bundle compliance– Each individual element compliance

Feedback to Individual Providers

Identify Gaps in Application of Evidence

• Set performance targets– IE: 90% compliance with obtaining lactates in 3 hours

• Prioritize area to work on first– Focus on screening and the 3 hour bundle first then

move to the 6 hour bundle• Understand the ‘why’ there are gaps

– “go and see”—walk the process, talk with front line staff– Cause and effect—Fishbone

• Define action plan—– Can use IHI Model for Improvement– PDCA—tests of change

• Success relies on a complex set of tasks being completed in a limited amount of time

• Requires data collection and analysis to determine the bottleneck(s)

• Must analyze the workflow for patients arriving in the ED as well as those who become septic after hospitalization

• QI/PI teams are a great resource when available• Multiple tools have proven successful• Some examples of diagnostic tools used for analysis, and

the “therapeutic” tools developed out of the analysis

Determining the Gaps: Understanding Why

30

§ Perform a “Go See” with ED and ICU staff and draw a Current State Map for the septic patient flow

§ Include Customer & Requirements, Supplier & Inputs, major steps, technology, information flow, rework loops, delays, and data boxes with job titles

§ If there is no septic patient presenting, consider:

§ Interviewing the people who would be involved in the sequence of the septic patient flow: ask them to demonstrate what they would do if they wee working with a septic patient

§ Simulating a patient: choose one of the staff to “be” a septic patient and observe the simulated treatment as the patient progresses to ICU management

Current State Mapping Exercise

Sepsis Patient Flow Template: Walk Ins

Walk Ins ICU

Supplier Inputs:

Customer

Requirements:

ER

AssessTriage Diagnose Resus-

citate

Query Pt.

Perform

Assessment

2. For each process step include job title of persons performing the step

3. For each queue quantify the delay time (D/T)4. Then total each to get L/T for the overall process

1. List the process steps below each box

% pt. screened: Total L/T to

diagnosis:

% bundle use:

Labs:

Meds:

IV’s:

Monitoring:

CVP:

MAP:

ScvO2:

SV:

Echo:

Total L/T toadmit:

If bundle is not used,

describe these

resuscitation components

Highlight the steps with the biggest issues

D/TD/T D/T ERD/T

Current State Issues

Process Box & Issue1

2

3

4

Top 2 reasons why1a1b2a2b3a3b4a4b

Cause and Effect Diagram

Set objective

Ask questions and make predictions (why)

Plan to carry out the cycle and data collection

(who, what, where, when)

Carry out the plan

Document problems and unexpected observations

Collect and begin data analysis

Analyze the data

Compare data to predictions

Summarize what was learned

What changes are to be made?

Next cycle?

The PDSA Cycle for Learning and Improvement1

ACT

STUDY

PLAN

DO

Planning a Test of ChangeWorksheet Example

When will you compare what happened to your prediction? Week of June 12th

When will you decide what to do next? Try it with all the nurses on the day shift and night shift for one week

SMALL TEST OF CHANGE

WHATdo you need to test this idea?

WHOwill be involved in the tests?

HOWwill you inform participants?

WHEREwill the test occur?

WHENwill the test occur?

HOWwill you know it is successful?

Test routine screening on medical unit

Paper screening formthat includes looking for infection, SIRS and organ dysfunction

3 staff nursed on the medical unit

Meet with 3 staff nurses to review the tool and process

9E medical unit Week of June 5th Screening tool was completed correctly without any confusion and same result is obtained by staff nurse and sepsis team member

SMALL TEST OF CHANGE

What did you predict will happen?

What happened? What did you learn? What are the next steps?

Routine sepsis screening

Screening form/process will be easy to follow and result in a correct screen

Screening process was easy and the results werecorrect

Nurses like having clear direction on the form for what to do with a positive screen for severe sepsis

Expand the test of change to the rest of the day shift and the night shift

Challenges

Challenges with the Bundles

• Timely antibiotics• 30ml/kg fluid bolus• Repeat lactate• Sepsis reassessment

• 3723 patients at 138 hospitals in seven countries (all patients from the PROCESS, PROMIS and ARISE trials)

• Prior to randomization >92% of patients were identified early, and provided the 3 hour bundle (including 2L of fluid and antibiotics-given within 70 minutes of presentation to ED)

• No difference in 90 day mortality between EGDT and Usual Care groups

• Authors stated: “It remains possible that general advances in the provision of care for sepsis and septic shock, to the benefit of all patients, explain part or all of the difference in findings between the trial by Rivers et al. and the more recent trials” NEJM , March 21, 2017

• In 2013, New York began requiring hospitals to follow protocols for the early identification

• April 2014 to June 30, 2016• 49,331 patients at 149 hospitals• 82.5% had the 3-hour bundle

completed within 3 hours (median time was 1.3 hrs)

• Longer time to completion of the 3 hour bundle was associated with higher risk-adjusted in-hospital mortality as well as longer time to administration of antibiotics (14% higher for both)

Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of

survival in human septic shock

*2,154 septic shock patients

*Effective antimicrobial administration within the 1st hour of documented hypotension was associated with increased survival in patients with septic shock.

*Each hour of delay over the next 6 hours was associated with an average decrease in survival of 7.6% (range 3.6-9.9%)

CCM 2006 Vol. 34 No.6

Antibiotics are Key

Each elapsed hour between presentation and antibiotic administration was associated with a 9% increase in the odds of mortality with sepsis of all severity strata

Increased Time to Initial AntimicrobialAdministration Is Associated With Progressionto Septic Shock in Severe Sepsis PatientsBristol B. Whiles, BS1; Amanda S. Deis, MS1; Steven Q. Simpson, MD2Critical Care Medicine. April 2017. Vol 45. Number 4

• Each hour until initial antimicrobial administration was associated with a 8% increase in progression to septic shock.

• Patients who progressed to shock had significant increase in hospital LOS (18.7 days vs 9.66 days) and mortality (30.1% vs 7%)

Antibiotics Challenges

Ø Appropriate initial antibioticsØ Guide for providers recommending the appropriate antibiotic based

on whether hospital or community acquired, source and your hospitals antibiogram

Ø Turnaround time---from indication to hangingØ ED vs ICU vs Floor

Ø Understand your current process and where the gaps are

Ø Make antibiotics rapidly availableØ Factors that showed delay administration

Ø Higher APACHE, older, presence of co-morbidities, HLOS before hypotension, dx of pneumonia, admin to academic hospitals & transfer from medical wards

Amaral ACKB, et al. Crit Care Med;2016;44:2145-2153

Fluid Boluses

Ø How fast should they be given?Ø Gravity or pressure bag

not by infusion pump

Ø What about dialysis patients?

Ø What about patients with CHF or low EF?

Fluid bolus is given rapidly, IV wide open,

pressure bag if necessary; goal is 500ml every 15-30

minutes

Heart Failure—Going to Flood My PatientNot Based in Evidence

• Rivers et al Study: % Ventilated Patients

Chronic coexisting conditions-CHF: Control 30.2% EGDT 36.7%

N Engl J Med 2001;345:1368-1377

Early Fluid Resuscitation is Key

↑ mortality with later fluid administration 13.3% (30 minutes) versus 16.0% (31 to 60 minutes) versus 16.9% (61 to 180 minutes) versus 19.7% (>180 minutes)

Increased Fluid Administration in the First ThreeHours of Sepsis Resuscitation Is Associated With

Reduced MortalityA Retrospective Cohort Study

Sarah J. Lee , MD , MPH ; Kannan Ramar , MBBS , MD ; John G. Park , MD , FCCP ; Ognjen Gajic , MD , FCCP ;

Guangxi Li , MD ; and Rahul Kashyap , MBBSCHEST OCTOBER 2 0 1 4 ]

After adjusting for confounders, the higher proportion of total fluid received within the first 3 hrs was associated with decreased hospitalmortality

Early Fluid Resuscitation is Key

Decrease in hospital mortality was observed primarily in patients with heart and/or kidney failure (p<0.04) who received at least 2 Liters fluid resuscitation for severe sepsis with lactate between 2.1-3.9

Critical Care Med

Early fluid initiation (30-120 minutes) was associated with significantly lower hospital mortality, mechanical ventilation, ICU admission, LOS and ICU days & no harm seen to the patients

Application of Fluid Resuscitation in Adult Septic Shock

User’s Guide to the 2016 Surviving Sepsis Guidelines Dellinger, CCM published ahead of print 1-2017

Repeat Lactate Strategies

• Repeat lactate can be drawn anytime after fluid bolus• Reflex lactate for any initial lactate greater than 2• 2nd lactate order included when first one is ordered

Reassessment

• Requirement changes in July, 2018 for CMS– Still a requirement for physician/APP to

reassess volume status and tissue perfusion, just no requirement to state how that reassessment occurred or what the outcome of the assessment was

– IE: “ perfusion reassessed; “sepsis reassessment done”

– Only need to do one out of 2 of the reassessment measurement (CVP, ScvO2, Echo, dynamic responsiveness)

• Strategies to comply with documentation requirements– Standard provider note or dot phrase– Expect that whomever orders the 30ml/kg

fluid bolus is responsible for the reassessment documentation

– Part of a sepsis checklist

Other Challenges and Barriers

• Executive support• Physician buy-in• New sepsis definitions• Data measurement/routine feedback• Antibiotic stewardship

Role of Executive Sponsor

• Review project plans • Review results from first team

meeting• Identify anticipated barriers that

senior leader can help address• Enlist support and help AND

ASK for a sponsor to be assigned to the project

Challenges with Physician Buy In

• Cook book medicine• “I know I can treat them

better” or “I have been treating this patient my whole career”

• “ I don’t have enough time”

Strategies to Address Buy In

• Use hospital sepsis mortality data and nationally data to show it makes up the majority of deaths

• Strong informal leaders connect individually• Identify who’s opinion they would respect and provide

discussion or feedback• Individual physician data on patients treated including

bundle compliance• Quick turn around time on data to change behavior

Challenges: New Sepsis Definitions

Sep-2 Definitions (used by CMS and coders)

• Infection• Sepsis: infection plus 2 or more SIRS• Severe Sepsis: infection plus 2 or more SIRS plus new

organ dysfunction • Septic Shock: severe sepsis with a lactic acid greater than

or equal to 4mmol/L OR continued hypotension (systolic BP<90 or 40mmHg decrease from their baseline) after initial fluid bolus (30ml/kg)

Sepsis 3: Singer et al, JAMA 2016. PMID: 26903338

• Sepsis is: ‘life-threatening organ dysfunction caused by a dysregulated host response to infection’– Sepsis-3 does away with:

• SIRS criteria (sepsis is pro- and anti-inflammatory)• Severe sepsis (sepsis = the old severe sepsis)• Antiquated concepts: sepsis syndrome; septicemia

• Sepsis: infection plus 2 or more SOFA (Sequential Organ Failure Assessment) points

• Septic shock: vasopressor-dependent hypotension + lactate >2

Sepsis-3 includes clinical criteria to predict life-threatening disease

SOFA

qSOFA: (have 2 or more of these, then evaluate for SOFA)

Respiratory Rate> 22Altered Mental StatusSystolic BP < 100mmHg

Challenges with New Sep-3 Definitions

• SIRS not part of the definition: – the most appropriate use for SIRS is that its presence prompts an immediate

search for both infection, as its possible source, and organ dysfunction, as its possible companion

• Late recognition– “sepsis is a problem only when life-threatening organ dysfunction is already

present fails to recognize the spectrum of the illness, minimizes the importance of infection to its evolution and as its principal driver and devalues systemic host response as a harbinger of the onset of organ failure”

• Doesn’t recognize ‘cryptic shock’• People will begin to use qSOFA as a screening tool

– qSOFA and SOFA are predictors of mortality; they are not test of early sepsis at risk to progress to organ failure

• Only their predictive ability for morality and prolonged ICU stay have been evaluated, not their utility in reducing mortality

Simpson, S. Chest. January 2018 SIRS in the Time of Sepsis-3

“As the physician say of hectic fever, that in the beginning of the malady it is difficult to detect but

easy to treat, but in the course of time, having been neither detected nor treated in the beginning, it

becomes easy to detect but difficult to treat”

Niccolo Machiavelli, 14th Century

Simpson, S. Chest. January 2018 SIRS in the Time of Sepsis-3

Coming Attractions!!

Recent Studies

Use of balanced fluids in critically ill adults resulted in a lower rate of the composite outcome of death from any cause, new renal replacement therapy or persistent renal dysfunction than use of saline

Angiotension II effectively increases blood pressure in patients with vasodilatory shock that did not respond to high doses of conventional vasopressors

Hour-1 Surviving Sepsis Campaign Bundle of Care

Intensive Care Med, May 2018

Clover Study(out of the ARDS Petal Network)

Hypothesis• Restrictive (vs liberal) fluid treatment strategy during the 1st 24hr of

resuscitation for sepsis-induced hypotension will reduce 90-day in hospital mortality

"conservative" (vasopressor first followed by rescue fluids)VERSUS"liberal" (fluids followed by rescue vasopressors)

Will reduce 90 day in-hospital mortality in sepsis induced hypotensionMethod• Multicenter, randomized prospective phase 3 trial• Intervention: protocolized fluid titration strategies for up to 24 hours• Sample: 2,320 patients planned to enrollment• Primary outcome: 90 day inpatient mortality• 50 Hospitals—acute and critical care (part of Petal Network)

Keys to Success

• Team in place with key stakeholders overseeing implementation• Project coordinator with lead clinical staff on each unit• Sepsis resource/coordinator rounds frequently on units• Strong physician leadership on team• Reminders to staff through use of bedside sepsis tools/checklist• Empowerment of nursing staff to prevent errors• Administrative support to help manage barriers• Review data monthly to identify opportunities for improvement-real

time follow up whenever possible• Provider specific feedback or report cards related to performance• Support from a collaborative• EDUCATION, DATA, COACHING,EDUCATION…….

SCN activities support ongoing communication, education and network building among health professionals passionate about improved sepsis care. Activities include:

• Educational webinars that highlight sepsis best practices in a variety of healthcare settings

• Active discussion and peer support via an online community

• Training and education opportunities• Resource drive to find information on

a range of topics, including core measures, clinical practice guidelines, patient screening and identification tools, education resources and more

JOIN NOW ATSEPSISCOORDINATORNETWORK.ORG

Our MissionTo provide sepsis best-practice resources and guidance to sepsis coordinators and all health professionals across the country

Questions?

Contact Information

Pat Posa RN, BSN, MSA, CCRN-K, FAAN

Quality Excellence LeaderSt. Joseph Mercy Hospital

Ann Arbor, [email protected]

Sepsis Solutions International LLC

Angela Craig APN,MS,CCNSClinical Nurse Specialist/ICU

Cookeville Regional Medical CenterCookeville, TN

[email protected]

mailto:[email protected]

SCN activities support ongoing communication, education and network building among health professionals passionate about improved sepsis care. Activities include:

• Educational webinars that highlight sepsis best practices in a variety of healthcare settings

• Active discussion and peer support via an online community

• Training and education opportunities• Resource drive to find information on

a range of topics, including core measures, clinical practice guidelines, patient screening and identification tools, education resources and more

JOIN NOW AT SEPSISCOORDINATORNETWORK.ORGOur MissionTo provide sepsis best-practice resources and guidance to sepsis coordinators and all health professionals across the country

Evaluating the current state of sepsis in your facility 7 ... · ©Sepsissolutionsinternational LLC 2018 Evaluating the Current State of Sepsis in Your Facility Pat Posa RN, BSN,

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