8/15/2018 1 1 Say ‘CHEESE’ 2 We are planning to take photos during today’s Learning Session. We plan to use the photos on our website and social media to showcase the great work being done in our state. If you prefer to NOT be photographed, please let a member of our team know.
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Say ‘CHEESE’ - Great Plains QIN · 8/15/2018 · SEPTIC SHOCK . Severe Sepsis with persistent hypotension Signs of end organ -lasting Increased Mortality . CMS Sepsis Bundles
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8/15/2018
1
1
Say ‘CHEESE’
2
We are planning to take photos during today’s Learning Session. We plan to use the photos on our website and social media to showcase the great work being done in our state.
If you prefer to NOT be photographed, please let a member of our team know.
8/15/2018
2
|Social Media
http://twitter.com/greatplainsqin
www.facebook.com/GPQIN/
Be part of our conversation|
https://www.linkedin.com/company/gpqin/
https://www.youtube.com/c/Greatplainsqinorg
Great Plains Quality Care Collaborative214 Nebraska Nursing Homes
Antibiotic Resistance is the ability of a bacteria to change so that antibiotics can’t kill or stop from reproducing. The bacteria become “resistant” and continue to multiply in the presence of therapeutic levels of an antibiotic.
Antibiotic stewardship is the coordinatedeffort that promotes the appropriate use ofantibiotics, improves outcomes, reducesantibiotic resistance and decreases the spreadof infections caused by Multi-Drug ResistantOrganisms (MDROs).
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Unleash the flying monkeys on sepsis…
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Objectives
Define sepsis and the symptoms and conditions in which sepsis should be suspected.
Describe why suspected sepsis is a medical emergency.
Identify sepsis screening tools for long-term care.
Identify discharge education tools and resources related to sepsis.
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Care Coordination Immunizations
Antibiotic Stewardship
Sepsis SIP
HRET HIIN
Nursing Home Care
Sepsis is the #2 reason for admissions and #1 reason for readmissions in the state of Nebraska.
Vaccination Rates: Nebraska Influenza: 57.6% Pneumococcal: 61.7% Madison County Influenza: 56.7% Pneumococcal: 58% Healthy People 2020 goal= 70%
Assisting with implementation of the CDC’s 4 CORE elements of outpatient antibiotic stewardship. 1) Commitment 2) Action for policy
and practice 3) Tracking and
reporting 4) Education and
expertise
1) Assisting with implementation of the CDC’s 7 CORE elements on Antibiotic Stewardship for Nursing Homes
2) Improving Immunization rates
3) Sepsis education around early identification and treatment
4) Infection Prevention
Working toward 20% all harm reduction and 12 % readmission reduction
Focus on early recognition and treatment of sepsis prehospital and in the community.
Sepsis Symptoms and Why Sepsis is a Medical Emergency
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Know the Risks. Spot the Signs. Act Fast.
Sepsis is | The body’s extreme response to an infection. It is a life-
threatening medical emergency.
Sepsis happens when| an infection you already have—in your skin,
lungs, urinary tract or somewhere else—triggers a chain reaction throughout your body. Without timely treatment, sepsis can rapidly lead to tissue damage, organ failure and death.
Who is at risk?| Anyone can get an infection and any infection can lead
to sepsis. People at higher risk include: Source: https://www.cdc.gov/sepsis/what-is-sepsis.html
• Adults 65 or older • People with chronic medical conditions, such as
diabetes, lung disease, cancer and kidney disease
• People with weakened immune systems • Children younger than one
Obtain blood cultures prior to the administration of antibiotics
Administer broad-spectrum antibiotics
Administer 30ML/KG crystalloid for hypotension or lactate levels > 4MMOL/L
Promote prompt imaging to confirm potential sources of infection
6-Hour Sepsis Bundle
Administer Vasopressors
Reassess volume status and tissue perfusion to ensure adequate resuscitation
Remeasure Lactate
Implement other supportive therapies as indicated by individual patients using algorithms and protocols.
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Health Research & Educational Trust (2017, February). Sepsis and septic shock change package: 2017. Chicago, IL: Health Research & Educational Trust. Accessed at http://www.hret-hiin.org/
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Sepsis Begins in the Community
73 y/o male – not feeling well, colon cancer, dizzy, weak, fever 2 minutes – dispatch receives call and toned out to EMS 5 minutes – EMS volunteers go to station and leave with ambulance 15 minutes – travel to and arrive on scene 15 minutes – assess patient, prepare for transport 20 minutes – leave scene for hospital, call report to hospital 5 minutes - arrive at hospital, transfer care to hospital providers 62 minutes after patient called 911 hospital care begins Physician onsite? Lab/x-ray onsite? Sepsis recognized and bundles started?
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Missed Opportunities
Community Setting • Early recognition of sepsis • Communication of suspected sepsis to physician, EMS
or hospital
EMS • Early recognition of sepsis • Communication of suspected sepsis to tiering ALS
EMS or hospital
Hospital • Early recognition of sepsis • Timely implementation of sepsis bundles
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We suspect SEPSIS
Time is…
In the case of a stroke, time is brain
In the case of heart attack, time is muscle
In cardiac arrest, time is life or death
In trauma…the golden hour
In sepsis, time is organ dysfunction - Carmen Polito, MD
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Polito, C.C. MD. 2016 Southeastern Critical Care Summit. (2016). Prehospital identification and management of sepsis. Available at https://www.youtube.com/watch?v=pk1CNflC-WU
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4 Ways to Get Ahead of Sepsis
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Prevent Infections
• Self-care of Chronic Conditions
• Vaccinations
Good Hygiene
• Hand Washing
• Cover nose/mouth when coughing
• Keep cuts clean and covered
Know the Symptoms • Infection
• Fever/Chills
• Short of breath
• Rapid heart rate
• Confusion
• Pain/Discomfort
• Pale, clammy or sweaty
Act Fast
• Call 911
• Go to ER
• State “I am concerned about sepsis”.
Sepsis Screening Tools for LTC
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GPQIN EMS Sepsis Alert
Sepsis Alert Criteria Initiate Sepsis Alert
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Post-Acute Care Sepsis Early Identification and Treatment Pathway and SBAR for Sepsis
Identify infection prevention strategies thatpromote a safe environment and quality of lifefor residents with multidrug resistantorganisms and Clostridium difficile in thenursing facility.
Describe the role of standard precautions increating a homelike environment for residentsin the nursing facility.
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Action | Next Steps
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Sharing and Questions
Thank you!!
GreatPlainsQIN.org
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CEs and Evaluation
4.0 Continuing Education Contact Hours awarded by Iowa Western Community College, Iowa Board of Nursing Provider #6
To receive your CE certificate, you MUST sign in todayand complete the evaluation
The evaluation will be sent to attendees after thisevent via email
EVAL/CE DEADLINE:• Gering/Lexington | August 31• Lincoln/Norfolk | September 14
This material was prepared by the Great Plains Quality Innovation Network, the Medicare Quality Improvement Organization for Kansas, Nebraska, North Dakota and South Dakota, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. 11SOW-GPQIN-NE-C2-216/0818