Stampede Sepsis: A Statewide Collaborative

Transcription

1 Stampede Sepsis: A Statewide Collaborative Kentucky Sepsis Summit August 24, 2016 T E R I H U L E T T, R N, B S N, C I C, F A P I C P R O G R A M M A N A G E R, I N F E C T I O N P R E V E N T I O N

2 CHA Sepsis Team Teri Hulett, RN, BSN, CIC, FAPIC Program Manager, Infection Prevention Sarah Hodgson, MS Project Manager and Data Analyst Nicole Huntley, MS, ACCNS-AG, RN Med-Surg Clinical Nurse Specialist Sepsis Coordinator University of Colorado Hospital Jennifer Rieske, RN, CCRN, SCRN Sepsis Coordinator Swedish Medical Center

3 The Colorado Landscape

4 The Problem National Sepsis Mortality Rate 20% - 50% Colorado Overall Sepsis Rate Colorado Sepsis Mortality Rate 7%* Pamela Popp 9.5%* Most (CO) hospitals hover around 21 percent, which is the average sepsis mortality rate in Colorado. 482 lives can be saved in CO by reducing sepsis mortality rate by 20%!! * Retrieved Colorado data from acute care hospital discharge claims data doi: /jogh

5 Recruitment Benefit of participation Tools/resources/checklists Ongoing education: Presented at all HEN Regional Meetings Site Visits, Coaching Calls, Webinars, Regional Meetings, Statewide Meetings Evidence/Strategies/Interventions Access to local and national experts Peer Mentorship

6 Statewide Approach Participating Hospitals 7 Hospital Types 5 critical access 2 general State Regions Western Slopes Eastern Region Southern Region Resort Region Front Range Region

7 Statewide AIM Prevent Severe Sepsis and Septic Shock Early recognition Standardized treatment Reduce Severe Sepsis Mortality Rates Educate on sepsis Save lives by reducing sepsis mortality 482 lives could be saved in CO with a 20% reduction in severe sepsis

8 Why Sepsis? Sepsis is the leading cause of death in non-coronary care intensive care units, with a mortality rate between 20 50% From , over 2,047,038 patients were admitted with a sepsis-related illness o 52.4% of sepsis patients are diagnosed in the ED o 38.4 are diagnosed on a non-icu ward o 12.8 are diagnosed in the ICU Levy MM Intensive Care Med Feb;36(2):222-31

9 What is the Surviving Sepsis Campaign The Surviving Sepsis Campaign (SSC) is a joint collaboration of the Society of Critical Care Medicine (SCCM)and the European Society of Intensive Care Medicine (ESICM) committed to reducing mortality from severe sepsis and septic shock worldwide.

10 Original SSC AIM 7-point Agenda: Building Awareness of Sepsis Improving Diagnosis Increasing the Use of Appropriate Treatment Educating Healthcare Professionals Improving Post-ICU Care Developing Guidelines of Care Implementing a Performance Improvement Program

11 Core Measure 2015 Sepsis became a Core Measure CMS selects recommended core sets of Clinical Quality Measures(CQMs) for Eligible Providers(EPs)based on analysis of several factors: Conditions that contribute to the morbidity and mortality of the most Medicare and Medicaid beneficiaries Conditions that represent national public health priorities Conditions that are common to health disparities Conditions that disproportionately drive healthcare costs and could improve with better quality measurement Measures that would enable CMS, States, and the provider community to measure quality of care in new dimensions, with a stronger focus on parsimonious measurement Measures that include patient and/or caregiver engagement

12 Most Expensive Condition

13 Mortality

14 Progress

15 The Work Sepsis Work is Team Work 3 different levels of participation 1. Active working team 2. The leadership group 3. Providers, including all stakeholders who have an interest in the change

16 Seconds Count... Every 3.5 seconds someone somewhere in the world dies from sepsis Many of these deaths are preventable

17 Early Identification

18 Bedside Nurses Empower nurses to recognize and report sepsis, severe sepsis, and septic shock Seconds count - time is tissue

19 Surviving Sepsis Campaign Bundles The key to achieving a reduction in mortality from severe sepsis is not just standardized evidence-based treatment, but equally important, the early recognition of sepsis. Statement from SSC Leadership on Time Zero in the ED

20 Compliance and Quality Improvement Achieving Compliance within the Resuscitation and Management Bundles Oxygen won t go where blood don t flow

21 Comprehensive Sepsis Management Use of measures recommended in sepsis guidelines Surviving Sepsis Campaign CDC Monitoring and surveillance Early warning score tool Reporting/documentation Report changes to physician Document clearly in medical record

22 Modified Early Warning Score (MEWS)

23 Keys to Survival Survival Early identification o Subtle signs and symptoms o Don t wait till your patient is hypotensive! Treat infection with appropriate antibiotics in a timely manner o For every hour antibiotics is delayed in a septic shock, the patient s risk of death increases by 7.6%. Source control o Antibiotics o Surgery The single most important intervention in treating sepsis Resuscitation with IV fluids and vasopressors if necessary (hemodynamic bundle) Emergency supportive care for acute organ dysfunction o Ventilator; Continuous Renal Replacement Therapy (CRRT); Prone Positioning Oxygen won t go where blood don t flow

24 Stages of Sepsis Seconds count time is tissue

25 SSC 3 Hour Bundle

26 Early Recognition and Treatment

27 Where is the Opportunity? The potential to save lives is ENORMOUS. Assuming that the reduction in mortality seen to date can be sustained and 10,000 hospitals comply with the SSC recommendations, we could save 400,000 lives if we treat only half of the eligible patients with the Surviving Sepsis Campaign Bundles

28 Sepsis Education

29 Site Visits

30 Sepsis Grand Rounds Conflict/Crossover between Sepsis and Antimicrobial Stewardship guidelines Engaging Physicians and Providers Effective Communication between nurses and providers Bundle Elements and Case Studies Take an ED Focus since this is where most of the patients will be showing up

31 Sepsis Workshops We are planning a four hour workshop: 60 minutes with the CMO and CNO 2 hours project time 1 hour wrap-up with the CMO and CNO Proposed content for the workshop: Review of sepsis workflow and recommendations for improvement Analysis of workflow with recommendations for improvement o Best practice o Core measures o HER optimization Recommendations for education to medical staff Review of screening tool and recommendation for improvement

32 Moving Forward Assessment of Current Practice Help in identifying where opportunity exists Assistance with sepsis assessment Forming the Team Evidence based suggestions on key players to be included on your team Advice for team recruitment Resources Evidence-based guidelines/tools Regional/Site Specific Training for teams and other staff members Coaching Calls/Sepsis Office Hours/Regional Meetings/Grand Rounds/Workshops Access Local Experts Data collection/analysis support (where applicable)

33 Sepsis: Getting it right Develop multidisciplinary team Define Time Zero Early Identification: EWS Tool Diagnosis/high level of suspicion Sepsis Bundle < 3 hours Time is tissue! Oxygen won t go where blood don t flow Early goal directed therapy (EGDT) is to restore microcirculation before mitochondria is permanently damaged Labs/Antibiotics/Fluids

34 We Have a Lot to Do! We established The Rory Staunton Foundation after our son s death from sepsis in April We seek to reduce the number of sepsis-caused deaths through education and outreach aimed at faster diagnosis and effective treatment of sepsis, particularly in children.

35 Who is the Next Face of Sepsis?

36 Thank You