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Why Sepsis for Improvement Project? Sepsis accounts for 10% of deaths annually
with a 30% mortality rate Number one cause of multiple-organ failure
and death in patients with critical illness Increased incidence without any significant
change in mortality over past 30 years 750,000 hospitalized cases annually with
210,000 deaths. Many more than Acute MI.
Angus DC, et al. Crit Care Med 2001;29:11303-10.
Sepsis Recognition and Treatment A Long Journey Starts at CCRMC 2004 – Physician Education on Early Goal
Directed Therapy
2005-2006 – Implementation of Severe Sepsis Order Set/ Nursing Education
2006-2008 Training workshops for Central line placements and CVP monitoring
Sepsis Recognition and Treatment A Long Journey Continues at CCRMC
Fall 2009 - CCRMC invited to join the INLP cohort on Sepsis
2009 – The sepsis team is made up of nurses, physicians, pharmacists, lab personnel, infection control and quality officers
2009 - A collaboration forms between the ER and Inpatient Units to tackle Sepsis
Project Objectives
Achieve 95% compliance in the use of the severe sepsis screening tool with all patients
Achieve at least 85% compliance in the use of the EGDT bundle
Reduce mortality due to sepsis at CCRMC at least 15%
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Interventions & Innovations
Developed sepsis screening tool and implemented in our ED, ICU, IMCU, Medical/Surgical Units
Automatic Meditech email alerts for every positive screen in the ED
All positive screens on inpatient units are faxed to a central location for data collection
Nurse initiated protocol to order a lactate for every positive screen.
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Interventions & Innovations
• Implemented the iStatlactate collection process in the ED Average turn-around-time
(order – reported) for iStatLactate results (ED)=24 minutes
Average turn-around time (order – reported) for non-iStat Lactate results (Inpatient units)= 54 minutes
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Education & Promotion Staff & MD buy-in◦ Educational Inservices◦ Screensavers◦ Poster boards◦ Unit Huddles◦ Rewards Sense of Pride
Education and Promotion
Unit Huddles/Case Studies
Monthly physician peer-review of septic patients
Required Nursing E-Learning Module
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Sustainability Plan Nursing Protocol Policy
Continue monthly team meetings to share data, TOC progress
CAPH Sepsis Initiative
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What Were Our Barriers?The Same Things that Were Necessary for Our Success
◦IndividualsNaysayers; Saboteurs; Late Adopters
◦TeamsBuilding and MaintainingRight People at the table at the Right time for the Right reasons
What Were Our Barriers?The Same Things that Were Necessary for Our Success
◦ Culture Many competing priorities and responsibilities Value what you know over what you can learn Difficulties overcoming the silos that exist within hospital culture
◦ Process Negotiating the best standard process to achieve shared goals Defining how the responsibility and accountability for those processes will be distributed and measured, respectively
How Did We Overcome Our Barriers?
◦ Individuals Individual team members were given the opportunity to develop their skills Individuals on the front line were engaged to be partners in the work
◦ Teams The team as a whole learned how to work more efficiently and effectively as a team and enjoy the fruits of our labors We continually constructed new subgroups of people to work on the components of the project that required their skills and input
How Did We Overcome Our Barriers?
◦ Cultures Ensure that all the subcultures of the hospital environment were represented on the team Value the diverse perspectives and solicit guidance on how to effectively work within their department to meet our shared goals
◦ Process How to modulate and apply different tools and tactics to engage the range of colleagues who we needed: from the early to the late adopters; from the skeptics to the yes (wo)men.
Lessons Learned Attend to the Key Ingredients for Organizational
Change
The importance of tenacity and patience
The importance of building relationships in the workplace to effect change
Overcoming resistance to change by appealing to the values and goals we all share: improving patient care and safety
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Lessons LearnedOrganizational Lessons:◦ Development of team structure to facilitate change◦ Embed the culture of Rapid Improvement into the team structure◦ Provide Support and Tools for Data Collection and Analysis◦ Structured Organizational Commitment to the process of improvement
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How Can We Apply These Learnings To Other Improvement Efforts?
Utilize the structures, skills and relationships developed as a model for future efforts
Reflect on what steps could have been improved and define how
Apply those reflections to future efforts as tests of change
Significance to Organization Early recognition and appropriate treatment
= Decreased mortality ◦ ”GOLDEN HOURS OF SEPSIS – TIME IS TISSUE”
Front line staff = Rapid recognition◦ “SCREENING FOR THE GOLDEN HOURS”
Nurse Empowerment = Earlier Identification Clinical Assessment Necessary
Implementation of evidence-based medicine innovations requires attention to principles of organizational change involving front-line staff
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