Making the Stars Align When Time Matters: Leveraging Actionable Data to Combat Sepsis

Transcription

1 Making the Stars Align When Time Matters: Leveraging Actionable Data to Combat Sepsis

2 Licking Memorial Health Systems

3 Patient Impact

4 Where did we begin? EDUCATION EDUCATION EDUCATION EDUCATION EDUCATION EDUCATION EDUCATION EDUCATION EDUCATION EDUCATION EDUCATION EDUCATION EDUCATION EDUCATION EDUCATION EDUCATION EDUCATION EDUCATION EDUCATION EDUCATION EDUCATION EDUCATION EDUCATION EDUCATION EDUCATION EDUCATION EDUCATION.and then some EDUCATION.

5 Sepsis Statistics are Grim Source: Sepsis Alliance. Sepsis Fact Sheet. MEDITECH. MEDITECH s EHR Alerts Clinicians to Possible Sepsis. October 2014.

6 Sepsis Statistics are Grim, cont d Source: Sepsis Alliance. Sepsis Fact Sheet.

7 Keys to Sepsis Survival Early Recognition The onset of sepsis can be subtle Urgent Attention Can progress very quickly if left untreated Rapid Treatment: Antibiotics IV Fluids

8 LMH Initiatives Establish a Sepsis Committee Establish a Sepsis Alert Protocol automatic ED acuity = RED Increase staff & physician awareness through ongoing education & case feedback Real-time case monitoring & ED case review Outlier identification and education with providers, pharmacists and nursing staff Standardize care via order sets and protocols

9 LMH Initiatives, cont d Screening of ALL triage patients for sepsis (using nurse protocols to initiate the Sepsis Alert, IV insertion, blood cultures, and fluid bolus if criteria met) Leverage technology to assist in sepsis identification via early warning systems Sepsis Visual Smart Board Real-time communication of at risk patients to providers

10 LMH Sepsis Team

11 Education & Awareness Campaign Overview of Sepsis Signs & Symptoms Sepsis Levels Treatment regimen CMS Sepsis Bundle Targeting: SNF and EMS Providers in our Community!

12 Sepsis Progression

13 Education & Awareness The Sepsis Bundle Within 3 hours of severe sepsis/septic shock identification: Obtain lactate level Obtain blood cultures Administer a broad spectrum antibiotic If hypotensive, administer 30mL/kg crystalloid fluid bolus Within 6 hours of severe sepsis/septic shock identification: Repeat lactate level, IF initial level was elevated >2mmol/L Vasopressors, IF hypotension persists after the 30mL/kg crystalloid fluid bolus Repeat volume status and tissue perfusion assessment

14 Early Management Bundle Results National Average: 44.2% Licking Memorial: 55.2%

15 LMH Information Technology Initiatives 1. Standardize care via order sets and protocols 2. Leverage existing EHR technology to assist in sepsis identification 3. Implement new sepsis surveillance system 4. Communicate condition of at risk patients in real-time 5. Detect patient deterioration earlier

16 Information Technology Initiative #1 Develop Standardized Clinical Workflows & Documentation

17 Standardized Physician Documentation CPOE Enabled Sepsis Specific Order Set

18 Standardized Physician Documentation (2) Sepsis Specific Physician Progress Note -Automatically populates key information

19 Standardized Physician Documentation (3) Sepsis Specific Progress Note - Consolidates CMS required elements

20 Information Technology Initiative #2 Improve Sepsis Identification using MEDITECH EHR

21 MEDITECH Sepsis White Paper Sepsis algorithm based upon the Surviving Sepsis Campaign Framework Build upon existing EHR functionality Generate EHR notifications for possible sepsis using real-time nursing documentation & a tailored sepsis identification algorithm

22 Sepsis Identification Nursing Documentation Nursing Sepsis Admission & Shift Assessments Calculates each patient s risk of Sepsis based upon vital signs, mental status & suspicion of infection

23 Room for Improvement A good first step but... We knew we could do better!

24 Information Technology Initiative #3 Implement Sepsis Surveillance System

25 Sepsis Visual Smart Board Based upon CMS Sepsis Bundle Criteria Aggregate all key data in a single location Every inpatient evaluated in real-time Provides comprehensive overview of patient s current condition Categorizes & color codes patients by risk Includes physician documentation regarding infection or suspicion of sepsis

26 Underlying VSB Algorithm

27 Sepsis Visual Smart Board, cont d

28 Improved Results Lab results & organ dysfunction elements necessary to stratify patients by categories of risk are incorporated Fewer false positives Less interruptions for physicians & staff Better visualization of at risk patients Earlier detection of sepsis onset

29 Information Technology Initiative #4 Facilitate Real-time Communication of Critical Alerts

30 Sepsis VSB Integration with Imprivata Cortext Secure Texting

31 Information Technology Initiative #5 Detect Patient Deterioration Sooner

32 Key Predictors of Patient Deterioration The two most important predictors of potential adverse events: Heart Rate Respiratory Rate

33 EarlySense Contact Free Continuous Patient Monitoring System

34 Continuous Patient Monitoring Benefits Alerts to adverse changes in vital signs either in real-time or as vital sign trends over time Assists in detection of patient deterioration earlier than when compared to traditional monitoring Nursing staff receive alerts via Vocera as well as to display monitors

35 Our Organizational Results... Overwhelmingly Positive!

36 Patient Impact Increased Identification of Sepsis

37 Patient Impact Code Blue Rate Reduced January December 2015 March December 2016 Code Blue Rate Per 1000 Patient Days Nearly a 45% decrease in Code Blue Rate

38 Patient Impact Decreased Sepsis Mortality Rates

39 Patient Impact Mortality Reduced

40 Top Reasons for Our Success High level of collaboration among Sepsis Team members Leveraging technology to assist in identifying sepsis in real-time Providing push alerts to clinical staff & physicians On-going review of outliers & continual process improvement related to sepsis care

41 Question & Answer Sallie Arnett, MS, RHIA, CHCIO Brian Thatcher