Agenda FHA Mission to Care HIIN Sepsis Trends and Progress Cheryl - PDF document

An Initiative of the Florida Hospital Association Hospital Improvement Innovation Network Surviving Sepsis: How Florida Hospital New Smyrna Reduced Sepsis Mortality September 20, 2018 Agenda FHA Mission to Care HIIN Sepsis Trends and Progress • Cheryl Love, RN, BSN, BS ‐ HCA, MBA, LHRM, CPHRM, Director of Quality and Patient Safety and Improvement Advisor Surviving Sepsis: How Florida Hospital New Smyrna • Reduced Sepsis Mortality – Karen Pittman, RN, Quality ‐ Clinical Auditor – Fortunata Hansen, MSN, RN, Director of Clinical Improvement FHA Mission to Care HIIN Resources • Upcoming HIIN Events and Opportunities • 1

What works? Early recognition • – It is important that we educate our communities • As many as 87% of sepsis cases originate in the patient’s community – EMS ‐ First responder training and sepsis alert protocols – In ‐ hospital ‐ Frequent assessment using established criteria The Surviving Sepsis Campaign Bundle: 2018 Update • – The 3 ‐ h and 6 ‐ h bundles have been combined into a single “hour ‐ 1 bundle” with the explicit intention of beginning resuscitation and management immediately. • Measure lactate level. – Remeasure if initial level is >2mmol/L • Obtain blood cultures prior to administration of antibiotics • Administer broad ‐ spectrum antibiotics • Begin rapid administration of 30ml/kg crystalloid for hypotension or lactate >4mmol/L • Apply vasopressors if patient in hypotensive during or after fluid resuscitation 2

Sepsis Post ‐ op Rate 8.00 7.00 6.00 Rate per 1,000 5.00 4.00 3.00 2.00 1.00 0.00 BL O ‐ 16 N ‐ 16 D ‐ 16 J ‐ 17 F ‐ 17 M ‐ 17 A ‐ 17 M ‐ 17 J ‐ 17 J ‐ 17 A ‐ 17 S ‐ 17 O ‐ 17 N ‐ 17 D ‐ 17 J ‐ 18 F ‐ 18 M ‐ 18 A ‐ 18 M ‐ 18 FL Rate 6.84 5.42 5.48 6.29 4.80 3.92 5.98 5.17 3.94 3.78 4.94 4.92 4.65 4.28 4.06 4.01 4.84 4.47 5.27 3.56 5.78 HRET HIIN Rate 4.72 3.78 3.98 3.82 3.84 3.58 3.52 3.75 3.43 3.36 3.74 3.36 3.61 3.37 3.53 3.50 3.91 3.88 3.85 3.38 3.58 # FL Reporting 73 67 68 68 70 70 70 69 69 70 69 69 70 69 69 69 67 67 66 65 63 #HRET HIIN Reporting 1,006 1,097 1,094 1,097 1,116 1,115 1,114 1,088 1,089 1,089 1,080 1,083 1,084 1,017 1,014 1,010 1,009 1,001 1,002 881 855 Source: Comprehensive Data System, September 9, 2018 Overall Sepsis Mortality 175.0 150.0 125.0 Rate per 1,000 100.0 75.0 50.0 25.0 0.0 BL O ‐ 16 N ‐ 16 D ‐ 16 J ‐ 17 F ‐ 17 M ‐ 17 A ‐ 17 M ‐ 17 J ‐ 17 J ‐ 17 A ‐ 17 S ‐ 17 O ‐ 17 N ‐ 17 D ‐ 17 J ‐ 18 F ‐ 18 M ‐ 18 A ‐ 18 M ‐ 18 FL Rate 154.8 151.2 150.4 141.5 163.7 145.5 150.2 151.9 127.5 139.6 157.1 135.8 150.0 144.7 136.3 149.2 163.4 129.5 135.6 138.9 118.3 HRET HIIN Rate 130.6 115.5 118.5 118.3 129.3 122.8 121.6 120.6 103.8 109.8 113.3 108.1 112.0 113.2 113.0 120.7 130.6 123.8 115.8 118.2 100.3 # FL Reporting 68 72 72 72 72 72 72 72 72 69 69 68 69 68 68 68 66 64 65 64 64 #HRET HIIN Reporting 1,156 1,341 1,344 1,354 1,366 1,364 1,366 1,354 1,348 1,331 1,325 1,322 1,327 1,315 1,289 1,278 1,270 1,260 1,259 1,131 1,107 Source: Comprehensive Data System, September 9, 2018 3

Hospital ‐ Onset Sepsis Mortality Rate 350 300 250 Rate per 1,000 200 150 100 50 0 BL O ‐ 16 N ‐ 16 D ‐ 16 J ‐ 17 F ‐ 17 M ‐ 17 A ‐ 17 M ‐ 17 J ‐ 17 J ‐ 17 A ‐ 17 S ‐ 17 O ‐ 17 N ‐ 17 D ‐ 17 J ‐ 18 F ‐ 18 M ‐ 18 A ‐ 18 M ‐ 18 FL Rate 238.33 247.00 256.68 267.44 313.77 250.00 287.26 273.22 264.06 313.25 303.03 257.81 299.38 323.67 232.00 306.12 320.65 238.81 254.55 290.80 292.17 HRET HIIN Rate 135.11 205.30 206.44 215.50 255.45 233.00 235.98 234.86 189.33 193.61 173.26 166.27 168.66 200.49 200.90 239.46 204.50 205.11 219.94 231.25 206.43 # FL Reporting 55 56 55 56 56 56 56 56 56 55 55 55 56 55 55 55 53 51 51 50 50 #HRET HIIN Reporting 1,104 1,260 1,262 1,269 1,279 1,276 1,270 1,256 1,250 1,251 1,250 1,245 1,249 1,238 1,222 1,212 1,210 1,199 1,198 1,102 1,074 Source: Comprehensive Data System, September 9, 2018 How Florida Hospital New Smyrna Reduced Hospital Onset of Sepsis Mortality Presented by: Karen Pittman, RN September 18, 2018 4

Objectives Our organization Identify sepsis mortality priority Results of analysis Adherence to best practices Effectiveness of actions Barriers Sustainability Our Legacy 2016 1954 Adventist 2018 1974 Opening Day Judge Health 74 Bed Tower Bert Fish System Acquires Bert Fish Medical Center 5

Our Trusted Team 112 719 332 114 Beds Employees Doctors Volunteers Serving Our Community 28,918 5,227 1,542 3,092 ER Visits Inpatient Inpatient Outpatient Surgeries Surgeries Admissions 6

Identified Sepsis Mortality as a Priority Results of Analysis New Florida Hospital acquisition High mortality Staff did not: Recognize early signs and symptoms Understand best practice treatment options Limited data available 7

Adherence to Best Practices Regional Sepsis collaborative Institute “Sepsis Alert” processes Standardization of care Access to data Algorithm and checklist Concurrent monitoring Frontline and Physician Region report champions Daily notification to providers Campus committee meetings Effectiveness of Actions Severe/Shock Mortality 0.0% 8

Barriers Lack of understanding Resistance with practice change No sense of urgency Frontline staff overload “Just one more thing for us to Lack of time do” Limited participation in practice Lack of best practice buy ‐ in change strategies Culture challenges Sustainability Education: Continued: Current nurses Regional sepsis collaborative Physicians Campus committee Ancillary staff Concurrent monitoring Community Communication New hire orientation CMO involvement Skills fair Sepsis champions 9

MTC HIIN Resources Change Packages and Top 10 • Checklists Date of Last Septic Event Poster • Post ‐ op Prevention Process • Improvement Discovery Tool Sepsis Podcast • LISTSERVs • HRET HIIN Website: www.hret ‐ hiin.org 10

MTC HIIN Resources Webinars and Coaching Calls • National Experts • Quality Improvement Fellowships • Patient and Family Engagement • Learning Collaborative Chasing Zero Infections Series • Safety Culture Survey • UP Campaign – SOAP UP, GET UP, • WAKE UP, SCRIPT UP FHA MTC HIIN Website: www.fha.org HRET HIIN Website: www.hret ‐ hiin.org MTC HIIN Upcoming Events • Sep. 21 – Fall Injury Prevention Strategies • Oct. 4 – Reducing Diagnostic Errors: Leading Practices • Oct. 5 – Readmissions Multi Visit Patient (MVP) Webinar #1 • Oct. 16 – TeamSTEPPS Check ‐ in Webinar • Oct. 18 – Falls Fishbowl #1 • Oct. 18 – MDRO Session #1 Check the MTC HIIN Upcoming Events Calendar for details and registration 11

HRET HIIN Quality Award Winner Congratulations, Florida Hospitals! HRET 2018 High Performance Award Florid ida Hos a Hospit ital al Ass Association Outstanding performance in In Support of the Partnership for Patients Program driving quality care, safety and value across its network of hospitals AHA Lead AH A Leader ershi ship Summ Summit HIIN Recept HII Reception, July July 25, 201 25, 2018 12

Contact Us We are here to help! HIIN@fha.org | 407 ‐ 841 ‐ 6230 State Lead: Kim Streit, FACHE, MBA, MHS, VP, Health Care Research & Information Svcs. Improvement Advisors: Cheryl Love, RN, BSN, BS ‐ HCA, MBA, LHRM, CPHRM, Director, Quality & Patient Safety Phyllis Byles, RN, BSN, MHSM, BC ‐ NEA, Clinical Performance Improvement Advisor Dianne Cosgrove, MS, RN, CPHQ, LHRM, Director of Clinical Quality Improvement Communications: Luanne MacNeill, Quality Initiatives Coordinator Data Support: Debbie Hegarty, Manager of Surveys & Special Projects Fellowships & Patient and Family Engagement: Allison Sandera, MHA, Project Manager 13