Kentucky Sepsis Summit. August 2016

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1 1 Kentucky Sepsis Summit August 2016

2 St. Elizabeth Healthcare About Us: - 7 facilities & over 1200 licensed beds - Serving the NKY/Cincinnati Region in: - Orthopedic Care - Heart and Vascular Institute - Diagnostic and therapeutic catheterization - Cancer center - Birthing center with a Level III NICU - Behavioral health center - Business health center - Sports medicine - Cardiac rehabilitation center - Women s wellness and breast center - Family practice residency program

3 Multidisciplinary team Key Deliverables Identify Current Processes & opportunities for improvement Standardize Processes and protocols for treatment of Sepsis patients Reduction of outcome measures to include mortality, LOS, readmissions within 30 days Meeting Schedules Initially team met weekly After go-live and processes implemented team changed to bi-weekly meetings Monthly meeting one month after go-live Ad-hoc teams meet as needed All team members are expected to: Participate fully Held accountable for assigned projects Maintain confidentiality Focus on improving patient outcomes Communication via meeting minutes, s, reports

4 Project Goals Improve Severe Sepsis and Septic Shock Bundle to 60% by December 2016 Develop system for early identification and treatment of Severe Sepsis by golive date Improve outcome of care as evidence by decreased mortality rate to <= 25th percentile Midas Comparative data base Improve outcome of care as evidenced decreased LOS, cost per case & readmissions

5 EMR Workflow Integration A sepsis screening tool will fire in EPIC to the RN & MD once it identifies a patient with: One manifestation of organ dysfunction The Best Practice Advisory will then request verification of suspected infection (the 3 rd criteria for identification of Severe Sepsis or Septic Shock)

6 Nurse Screening BPA View Automatically populates recent lab values here. BPA is a Screening Tool only *Nurse will gather data/use clinical judgment *MD will diagnose & prescribe If no evidence to suspect infection, RN must click RN: No documented/ suspected infection, & the checkmarks for orders will disappear. Nursing orders populate per protocol once BPA accepted. Check next to the applicable criteria to justify presence of 2 or more SIRS and 1 or more Organ dysfunction.

7 Physician Screening BPA View BPA is a Screening Tool only MD will still need to diagnose & prescribe Automatically populates recent lab values & vitals here. You can add Severe Sepsis or Septic Shock to your problem list from the BPA If no evidence to suspect infection, MD must click I certify no current Sepsis. the checkmarks for the orders & criteria below will disappear.

8 Nursing Protocol Order Set Allows the nurse to initiate some of the time sensitive lab orders. Nurse must immediately call MD & pull up EPIC orders to obtain orders for Severe Sepsis or Septic Shock.

9 Nursing Protocol Sepsis Bundle

10 Nursing Protocol Sepsis Bundle

11 METRICS for Success Mortality Length of Stay Core Measure Compliance Readmission Rates

12 Sepsis Quality Initiative 12 Sepsis Mortality October Sepsis Initiative Begins Sepsis Mortality Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 5

13 Sepsis Quality Initiative 13 Sepsis Length of Stay October Sepsis Initiative Begins Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16

14 Sepsis Quality Initiative 14 Sepsis Core Measure Compliance (%) Core SEP1 - Early Management Bundle, Severe Sepsis/Septic Shock 60 October Sepsis Initiative Begins Sep 2015 Oct 2015 Nov 2015 Dec 2015 Jan 2016 Feb 2016 Mar 2016 Apr 2016 May 2016 June 2016 July-16 0

15 Sepsis Quality Initiative 15 Sepsis Readmissions HW Readmissions Sepsis Readmissions October Sepsis Initiative Begins 30% 25% 20% 15% 10% 5% Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 0%

16 Dashboard

17 Lessons Learned Lessons Learned Get the right people at the table: Lots of sub-groups were working on Sepsis. Once we corralled the correct stakeholders the meetings went from 6-10 people to almost overnight. Medical leadership is key ED, ED, ED Listen to feedback and make appropriate changes: Example: The Physician suggested that the Sepsis Screening BPA no longer fire upon immediately opening the chart. The Physicians needed to be able to review the patients chart prior to making a decision about the sepsis diagnosis.

18 Questions? Sara Briggs MSN, NEA-BC St Elizabeth Healthcare

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