Sepsis Six – A Call to Action in Reducing Sepsis Mortality SSM Health St. Mary’s Hospital, Janesville Kathleen Glenn RN,BSN,MBA VP Patient Services/CNO
Situation: Sepsis • We know that a delay in recognizing and treating sepsis can mean the difference between life & death for our patients.
Background: A Call to Action • In the spring of 2012 our mortality rate was at 1.76 upon review of our mortality cases we noted that a one of the patients had been septic and this was not identified during the patient’s hospital course. • This was a call to action for us!
A Team approach • The identification and treatment of sepsis is complicated. • How do we harness all the knowledge and expertise required to provide the best care? • In 2013 our hospital critical care committee assisted in providing oversight for sepsis improvement.
Assessment: Evidence Based Approach • Critical Care committee formed and performed literature review, based on this the following strategies were implemented: • Developed “Sepsis Algorithm” • Created paper checklist • Implemented rapid response protocol and team called “Sepsis Six” • Performed staff education • Performed physician education
Sepsis Rapid Response • Activated by ANY staff member by calling the operator. • Operator then pages the Sepsis Rapid Response Team to patient’s room. • Team arrives and assesses patient, screening patient for sepsis, severe sepsis, or septic shock. • If the patient does have severe sepsis or septic shock, the rapid response team assists the bedside nurse in completing the required bundle elements. • Each discipline takes ownership of things they can control. • Example: Lab ensuring blood cultures & lactic acid are ordered and collected; Pharmacy ensuring that a broad-spectrum antibiotic has been ordered and is readily available for nursing staff; etc. • If the patient does not have severe sepsis or septic shock, care is de- escalated as appropriate.
Sepsis Rapid Response • Rapid Response Team Members • Hospitalist • ICU Nurse • ED Nurse • Nursing Supervisor • Primary Nurse • Phlebotomist • Pharmacist • Sepsis Coordinator
How do we know we are improving: • Sepsis coordinator performs concurrent review of patients daily • Implement a visual “Sepsis Scorecard” with data from each piece of the SEP -1 measure. • Appropriate cases referred by Medical Directors for Physician Peer Review. • CDI (Clinical Documentation Improvement) review of all sepsis cases to ensure the appropriate risk of mortality is documented in the medical record. • Recognition letters for exceptional care sent out to individual staff members and their respective leaders. • Sepsis case studies presented at staff department meetings.
Tools Developed
Recommendation What have we learned?
Lessons Learned: One and done, is not Done! • One rollout of sepsis education in 2013 was not enough. • Opportunities identified after initial roll out: • Lack in data collection • Inconsistencies in rapid response use • Roles and responsibilities of rapid response members not clearly defined • Resistance from hierarchy • Lack of structured feedback to clinicians on sepsis cases • Formal recognition did not exist
Sepsis Mortality Rates 2 1.8 1.76 1.6 1.4 1.34 1.3 1.2 1 0.8 0.72 0.69 0.6 0.52 0.4 0.23 0.2 0 2012 2013 2014 2015 2016 2017 2018 Sepsis Mortality
Sepsis Coding St. M t. Mar ary's Hos ospita pital l - Jane anesville ille Sever ere S e Seps epsis is/Septic eptic Shoc hock k Cas Cases es 80 80 100.00% 100.00% 90.00% 90.00% 70 70 80.00% 80.00% 60 60 70.00% 70.00% 50 50 60.00% 60.00% 40 40 50.00% 50.00% 40.00% 40.00% 30 30 30.00% 30.00% 20 20 20.00% 20.00% 12 12 11 11 10 10 10 10 9 9 9 8 8 8 8 8 7 7 10 10 6 6 6 5 5 5 4 4 10.00% 10.00% 3 2 0 0.00% 0.00% Ca Case ses Meeting SEP-1 Co Coded with R65 R6520-1 % % Wi With R6 R6520-1
Sepsis Best practices • Standardize approach to Sepsis. • Sepsis scorecard. • Dedicated Sepsis Coordinator reviews cases concurrently and retrospectively. • Sepsis Rapid Response Team – all staff are empowered to call when patient meets criteria. Team members have designated roles. • Checklist created for Physicians to ensure all bundle requirements are met and documented. • Root Cause Analysis performed on all outliers, opportunities to improve are identified and communicated. • Peer review for outliers. • Monthly case studies shared at all department and Hospitalists meetings. • CDI review of all Sepsis cases with appropriate queries to capture severity of Sepsis. • Lessons learned shared monthly hospital wide. • Recognition for exceptional care. • Timely Palliative Care consults for goals of care conversations.
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