Embed Size (px)
Citation preview
The Henderson Repository is a free resource of the HonorSociety of Nursing, Sigma Theta Tau International. It isdedicated to the dissemination of nursing research, research-related, and evidence-based nursing materials. Take credit for allyour work, not just books and journal articles. To learn more,visit www.nursingrepository.org
Item type Poster
Format Text-based Document
Title Reducing Sepsis Mortality: A Quality ImprovementInitiative, Leveraging Technology to Empower Nurses
Authors Walch, Pamela; Tinkcom, Summer
Downloaded 5-Jun-2018 04:13:04
Link to item http://hdl.handle.net/10755/623054
Pre-hospital care
• EMS sepsis protocol & “Code Sepsis”
• Skilled Nursing Facility outreach
• Public sepsis awareness & advocacy
Transitions of care
• ED Provider & Nurse EMB hand-offs
• Sepsis survivor education
• Admissions & readmissions
Additional AtlantiCare Sepsis Core Team Members
• E. Hamaty, D.O., FACCP, FACOI & S. Dietrich MHA,MSN., & R. Davis Bohs, BSN, RN, CNOR
• Quality Management: N. Baylon & J. Begasse BSN, RN, CPHQ. IT Analysts: D. Cook, & K. Connell, BSN, RN
References
Centers for Disease Control and Prevention. (2016). Making health care safer. Retrieved from http://www.cdc.gov/vitalsigns/sepsis
Gawande, A. (2010). The checklist manifesto: How to get things right. New York: Metropolitan Books.
Girbes, AR., Robert, R., Marik, P.E. (2015). Protocols: help for improvement but beware of regression to the mean and mediocrity. Intensive Care Med, 41(12): 2218-20
HCUP Statistical Brief #20, May 2016. National Inpatient Hospital Costs: The Most Expensive Conditions by Payer, 2013, https://www.hcup-us.ahrq.gov/reports/statbriefs/sb204-Most-Expensive-Hospital-Conditions.jsp
Liu, et al. Hospital Deaths in Patients With Sepsis From 2 Independent Cohorts, JAMA. 2014;312(1):90-92. doi:10.1001/jama.2014.5804, http://jamanetwork.com/journals/jama/fullarticle/1873131
Sepsis Alliance Launches New Tools and Resources for Sepsis Awareness Month 2017, June 1, 2017. http://www.sepsis.org/sepsis-alliance-news/new-tools-resources-sepsis-awareness-month-2017/
Wang, et al. National variation in United States sepsis mortality rate: a descriptive study International Journal of Health Geographics 20109:9 https://doi.org/10.1186/1476-072X-9-9
National • Sepsis kills an American every two minutes; implicated in as many as 50% of all
hospital deaths & is the most expensive condition treated in US hospitals
• 80% of deaths are preventable - early intervention increases the chance of survival
• Identified “Sepsis Belt” - clustered mortalities
• Surviving Sepsis Campaign aligns with The Centers for Medicare & Medicaid
Services (CMS) SEP-1 Measure evaluating quality of sepsis care at hospitals
• Screening tools & protocols improve outcomes; by streamlining tasks & collaborative
adherence to early management bundles (EMB)
Local • AtlantiCare sepsis mortality rate in 2014 was comparable to NJ state average of 32%
• AtlantiCare introduced a hospital wide sepsis protocol & sepsis team in 2015
• Member of New Jersey Sepsis Learning & Action Collaborative (NJ Hospital
Association NJHA) in 2015
• 2015 a Plan-Do-Check-Act (PDCA) team formed to reduce sepsis mortality by 20%
Reducing Sepsis Mortality: A Quality Improvement Initiative,
Leveraging Technology to Empower Nurses Pamela Walch, MSN, RN-C (Quality Management)
Summer Tinkcom, MSN, RN (Nurse Informatics Specialist)
Purpose
Acknowledgements & References
Implications for Practice
Relevance & Significance
Strategy & Implementation
Utilize Clinical Decision Support (CDS) tools within the electronic
health record (EHR) to facilitate early sepsis identification and
treatment to improve AtlantiCare’s sepsis mortality rate by 20%
Empowers RN
• Critical thinking
• Early treatment
• Triggers Sepsis Response Team
• ED nurse protocol
Guides Practice
• Sepsis policy & protocol
• Groups tasks
• Defines roles
• Guides transitions of care
Fosters Teamwork
• Partnering to save tissue & lives
• Educators & champions
• Interprofessional steer team
• Quality Team: abstracting, trending & tracking of SEP-1/EMB & celebrating success & exploring opportunities
Clinical Decision Support
• Cerner St John’s Cloud algorithm mines patient data
• Fires real-time SIRS or Severe Sepsis alerts if criteria met
• EMB & electronic pathway
• Automated documentation
System Enhancements
• Analytics for compliance & outcome tracking
• Mitigation plan for system failures- “alert for the alert”
• Automated repeat lactate
• Focused assessment alert
600 Bed Teaching Hospital 3 ED’s
> 31,000 annual admissions
• PDCA mortality goal of 20% met - check cycle drives new action plans
• Hospital-wide sepsis protocol resulted in earlier recognition of sepsis with
improving rate of adherence to CMS EMB bundles
• Early recognition alerts are 76% accurate in diagnosing sepsis
• Received Healthgrades Distinguished Hospital of Clinical Excellence in 2017
(30.5% less risk of dying from Sepsis)
Outcomes
Go Live- Oct’15
Alerts
76% Accurate
Questions? Email- QM: [email protected] IT: [email protected]
Evaluation
Performance Improvement
44th Biennial Convention, 28 Oct- 1 Nov 2017
Patient
Advocacy
Exploring Sepsis
Coordinator Role
Member NJHA &
Premier Quest
Hospital
Improvement
Networks (HINN)
