Recognizing Early Sepsis Signs Improves Patient Care

Sepsis Inpatient Pilot Project

Recognizing Early Sepsis Signs

Improves Patient Care

C4 | Nipping Infection in the Bud February 25, 2016 Thursday

1430-1530

Sepsis Inpatient Pilot Project

We are unable to identify any

potential conflict of interest

and have nothing to disclose.

Background

• Early recognition and intervention of Sepsis improves patient outcomes.

• Despite significant work done in

Emergency Departments (ED), there is still a gap between early identification of patients who are clinically deteriorating related to Sepsis and timely investigation and treatment.

• It is imperative to expand pivotal work around Sepsis Screening and Treatment from EDs to in-patient units.

Project Goal

• To reduce in-patient Sepsis morbidity and mortality through early identification, timely intervention and appropriate monitoring using best clinical practices and achieving seamless transitions of care.

Purpose

• To standardize care of in-patients developing early sepsis through implementing a Sepsis Screening Tool and piloting a new Early Sepsis Pre-Printed Order Set.

Methods

• Pilot units: CP10CD Acute Medicine units at Vancouver General Hospital (VGH)

– Acute Hospitalist Units

– 24-bed patients

• Pilot period: October 2014 -October 2015

• Sepsis QI Interdisciplinary team formed in collaboration with the British Columbia Safety & Quality Council (BCPSQC)

• Small PDSA cycles, refinement of Sepsis tools

Tools

Assumptions

We’re going to save the world!

“You begin saving the world by saving one man at a time; all else is grandiose romanticism or politics.”

Charles Bukowski

Results

24 in-patients developed Sepsis Oct 2014-Aug 2015

– Group 1: 15 patients: nurse identified early sepsis symptoms AND physicians completed PPO

– Group 2: 4 patients: nurse identified early sepsis, but physician did not use the PPO

– Group 3: 5 patients: nurse missed the early sepsis signs

Results

Values based on

documentation of initial

SIRS symptoms

Identified with PPO

Used

N=15

Identified and no PPO

N=4 Missed Cases

N=5

% Lactate Ordered

100 50 20

% Blood cultures

ordered

73 25 20

% IV Fluids ordered

73 100 40

% Antibiotics ordered

93 75 100

% BC done before

antibiotics

100 25 20

Time to obtain lactate

specimen

49 min (average)

Range: 20-150 min

20 min (average)

Range: 1-40 min n=2

8 hours

Range: 8 hours n=1

Time to obtain blood

cultures

40 min (average)

Range: 20-90 min

2.5 hours

Range 1-4 hours

12 hours

Range: 9-15 hours

Time to initiate

fluids

23 min (average)

Range: 1-80 min

105 min

Range: 30-180 min

9 hours

Range 8-10 hours

Time to administer

first dose antibiotics

55 min (average)

Range: 10-150 min

Unknown4 12.3 hours

Range 9-18 hours

Challenges Ongoing engagement of stakeholders and sustainability of program

“Difficult roads often lead to beautiful destinations.”

Anonymous

Biggest Change

Empowerment among staff “You can, you should, and if you’re brave enough to start, you will.” Stephen King

Significant Lesson

The importance of Team "Alone we can do so little, together we can do so much." Helen Keller

Sepsis Poster for BC Quality Forum

Acknowledgement

• Dr. David Sweet

• Chantelle Pamplin

• Leighanne Mackenzie

• Dr. Vandad Yousefi

• Dr. Julian Mackenzie-Feder

• Alison Beaty

• Suzanne Miller

• Bryn Lander

Jenifer Tabamo, RN, BSN, MSN Clinical Nurse Specialist Medicine Program, Vancouver Acute Vancouver General Hospital Tel: 604-875-4111 Local 64143 BB: 604-803-1862 Email: [email protected]

For more information…

Doris Bohl, RN, BSN Clinical Nurse Educator Units CP 7th Floor and CP 10 CD Vancouver General Hospital Office: 604-875-4111 local 69424 Mobile: 604-809-1279 Email: [email protected]