1/26/2018 Sepsis Webinar Series 2018 Presenter: Angela Craig, APN, MS, CCNS Tennessee Center for Patient Safety: Sepsis Topic Lead Rhonda Dickman, MSN, RN, CPHQ Clinical Quality Improvement Specialist 615-401-7404 - office 706-570-5700 - mobile rdickman@tha.com 1
1/26/2018 Sepsis Collaborative • Sepsis professionals • Shared learning and networking • Collaborative efforts to reduce sepsis mortality in Tennessee • Quarterly face-to-face meetings at THA – THA HIIN hospitals can receive travel support • Monthly conference calls Next meeting: Friday, February 2 nd at THA Sepsis Consultation Services • Consultant Angela Craig, APN, MS, CCNS • For THA HIIN hospitals • Conducted on site at your hospital • Tailored to meet your unique interests and needs “It helped to have someone from "the outside," to go over what we had accomplished so far & identify our needs, our strengths and where we needed to improve to meet our goals .” 2
1/26/2018 Sepsis Readmissions Workshop • Save the Date - May 9, 2018 • In partnership with Qsource – Will include nursing homes, home health agencies, and other post-acute providers Sepsis Webinar Series • Four-month project • 8 webinars (recorded) – 4 instructional – 4 sharing/coaching • One-hour individual coaching call with Angela for interested THA HIIN hospitals • Post-project evaluation 3
1/26/2018 Sepsis Webinar Series TIER 1: Organizational Consensus that Sepsis be Managed Early and Aggressively • January 26, 2018 – Introduction to topic • February 9, 2018 – Sharing / Touch Base Sepsis Webinar Series TIER 2: Early Screening with Tools and Triggers • February 23, 2018 – Introduction to topic • March 9, 2018 – Sharing / Touch Base 4
1/26/2018 Sepsis Webinar Series TIER 3: Implementation of the Sepsis Bundles • March 23, 2018 – Introduction to topic • April 13, 2018 – Sharing / Touch Base Sepsis Webinar Series TIER 4: Measuring Success • April 27, 2018 – Introduction to topic • May 11, 2018 – Sharing / Touch Base 5
1/26/2018 Pre-Assessment: Tell us about your sepsis program SEPSIS PROGRAM DEVELOPMENT TIER I AN G E L A C R AI G AP N , M S , C C N S I C U C C N S & S E P S I S F AC I L I T AT O R AT C R M C Angela’s Contact Information: acraig@crmchealth.org 931-239-4904 (cell) 6
1/26/2018 GOALS FOR TIER 1 • Is your executive leadership on board? • Do you have a sepsis coordinator or someone who is filling that need? • Do you have champions for this project – they need to be positive and respected individuals from the ED, ICU and Infection Prevention • Have you developed an interdisciplinary team? • What bedside nurses are on the team? • Do you have meeting scheduled for this very important group? • Do you feel the culture of safety is a priority? • Has a team charter been developed with mission vision and team goals? • What is your baseline data? (can use CMS data) • Have you educated your team to understand the latest guidelines and pathophysiology KEEP GAP ANALYSIS FORM CLOSE 7
1/26/2018 SEPSIS PRACTICE COLLABORATIVE MODEL 4 TIER PROCESS FOR PROGRAM IMPLEMENTATION Measuring Success CQI 1 Implementation of the Sepsis Bundles Early Screening with Tools and Triggers Organizational Consensus that Severe Sepsis Must be Managed Early and Aggressively Hand Washing VAE (VAP) Bundle BSI CAUTI Infection Prevention Documentation Improvement 1 Continuous Quality Improvement ~ Accurate Coding Adapted from: Sepsis Solutions International 15 SEPSIS PRACTICE COLLABORATIVE MODEL 4 TIER PROCESS FOR PROGRAM IMPLEMENTATION Measuring Success CQI 1 Implementation of the Sepsis Bundles Early Screening with Tools and Triggers Organizational Consensus that Severe Sepsis Must be Managed Early and Aggressively Hand Washing VAE (VAP) Bundle BSI CAUTI Infection Prevention Documentation Improvement 1 Continuous Quality Improvement ~ Accurate Coding Adapted from: Sepsis Solutions International 16 8
1/26/2018 TIER I: ORGANIZATIONAL CONSENSUS AND SUPPORT MILESTONES AND CHECKLIST 1. Define Sepsis Program Goal and aligned with organizational goals 2. Identify Executive sponsor 3. Collect Baseline Data — essential step 4. 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 6. Begin to define action plan and timeline for program development and implementation 17 1. DEFINE SEPSIS GOAL: DEVELOP PROJECT TEAM CHARTER Problem Statement: Severe Sepsis is Common and Deadly Team Members Goals ED, ICU, Patient Care Unit Representatives, Administration, Reduce severe sepsis mortality (make Medical Staff, Nursing, the goal specific and measurable) Pharmacy, Performance Improvement, Case Management, Laboratory Business Case Scope In comparison to other ICU patients, severe sepsis patients have a higher Severe sepsis patients in the ED, ICU, mortality rate, increased LOS, and an and patient care units increased need for a ventilator Milestones Benefits Implementation of Tiers 1, 2, 3, and 4 Potential to improve outcomes 2014 CHE Trinity Health, Livonia, 18 MI 9
1/26/2018 ECONOMIC IMPLICATIONS OF AN EVIDENCE-BASED SEPSIS PROTOCOL: CAN WE IMPROVE OUTCOMES AND LOWER COSTS? Objective • To determine financial impact of a sepsis protocol designed for use in the ED in a Academic, tertiary care hospital in US Design • Analysis of results from recent prospective study comparing outcomes in patients with septic shock before and after initiation of sepsis protocol • Adults (n=120) who sequentially presented to ED with septic shock, specifically • At least two systemic inflammatory response syndrome (SIRS) criteria • Known or suspected infection (based on radiologic imaging and clinical suspicion) • Shock requiring both fluid resuscitation and vasopressor administration Shorr AF et al. Crit Care Med . 2007;35:1257 – 1262. • ED = Emergency Department 20 10
1/26/2018 SUMMARY OF RESULTS • Post-protocol, savings of ~$6,000/patient observed • Translated into total cost difference of $573,000 between the two groups • Post-protocol, ICU costs reduced by ~35% (p=0.026) and ward costs fell by 30% (p=0.033) • Protocol resulted in a reduction in overall hospital LOS of 5 days (p=0.023) • Pre-protocol, 28-day mortality rate was 48.3% vs. 30.0% following protocol initiation (p=0.040) • Shorr AF et al. Crit Care Med . 2007;35:1257 – 1262. ICU, intensive care unit; LOS, length of stay TIER I: ORGANIZATIONAL CONSENSUS AND SUPPORT MILESTONES AND CHECKLIST 1. Define Sepsis Program Goal and aligned with organizational goals 2. Identify Executive sponsor 3. Collect Baseline Data — essential step 4. 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 6. Begin to define action plan and timeline for program development and implementation 22 11
1/26/2018 THE ROLE OF EXECUTIVE SPONSORSHIP 1. Sponsors are executive leaders explicitly tied to a process being improved. 2. Sr. executives round regularly (q week, q 2 weeks) on process aims, goals, targets, outcomes with the frontline team. Informative, not punitive. • Accountable, not “in • trouble” 3. Sponsors remove barriers to progress. 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 12
1/26/2018 ANY CHALLENGES/BARRIERS/QUESTIONS RELATED TO: Setting up your team (getting champions) Creating your team charter Getting an executive sponsor 25 TIER I: ORGANIZATIONAL CONSENSUS AND SUPPORT MILESTONES AND CHECKLIST 1. Define Sepsis Program Goal and aligned with organizational goals 2. Identify Executive sponsor 3. Collect Baseline Data---essential step 4. 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 6. Begin to define action plan and timeline for program development and implementation 26 13
1/26/2018 BASELINE DATA COLLECTION PROCESS: DEFINING CURRENT STATE • Pick time period for medical record query • Sample size: minimum of 20 pts per ICU • Query strategies: • ICD 9 codes: 785.52 and 995.92 • Patients in ICU on 1-2 antibiotics, vasopressor (review charts to see if meet criteria for severe sepsis with lactate > 4 or septic shock before including in outcome data or process data • Select Data Collection Elements • Outcome: mortality, cost per case, LOS • Process 27 SEP-1 SEP-1 TO BE COMPLETED WITHIN 3 HOURS OF TIME OF PRESENTATION † : 1. Measure lactate level 2. Obtain blood cultures prior to administration of antibiotics 3. Administer broad spectrum antibiotics 4. 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. 14
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