Code Sepsis: Wake Forest Baptist Medical Center Experience
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- Egbert Parker
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1 Code Sepsis: Wake Forest Baptist Medical Center Experience James R. Beardsley, PharmD, BCPS Manager, Graduate and Post-Graduate Education Department of Pharmacy Wake Forest Baptist Health Assistant Professor Pharmacology Course Director Wake Forest School of Medicine
2 Wake Forest Baptist Medical Center 885-bed academic medical center >180 adult ICU beds NCI-designated cancer center Level 1 trauma center Mature Antibiotic Stewardship Program
3 Where We Came From (2011) Early Warning System (EWS) in place Rapid Response (RR) Team Sepsis order set Antibiotic recommendations based analysis of institution s pathogens Sepsis-related mortality index twice rate of top 10 best-performing University HealthSystem Consortium (UHC) Hospitals
4 2-Day Kaizen Event Participants: nursing, pharmacy, respiratory care, RR, performance improvement, and medical staff from medicine, surgery, neurology, and anesthesiology Analyzed data related to sepsis care and outcomes Divided into groups to develop solutions
5 Outcome of Planning Meetings Educational campaign House-wide information on sepsis Targeted communication to individual disciplines on importance of performing their duties and doing them promptly Code Sepsis Standardized process for early identification, communication, and intervention of patients with sepsis
6 Code Sepsis Process RN calls RR and First Call Provider for EWS 8 RR performs sepsis screen If positive ( 2 SIRS criteria + possible infection), emergency response system contacted Text page sent to Inpatient Pharmacy Respiratory therapy Blood gas lab ICU triage nurse Each team member provides care
7 Pharmacy s Role Pharmacy charged with facilitating administration of ABX within 60 minutes Divided process into 3 stages Stage 1: Time from recognition of probable sepsis to ABX ordering Pharmacist as timekeeper Unit called if no new ABX orders within 15 min Protocol allowing pharmacist to select and enter sepsis ABX if provider is busy with other aspects of care
8 Pharmacy s Role (continued) Stage 2: Time from ABX order to unit delivery Pharmacists on look out for ABX orders for Code Sepsis patient Priority of ABX order maintained Verbal these are Code Sepsis ABX handoffs in each step of medication process Stage 3: Time from unit delivery to administration Special stat stickers Guidance to RN regarding ABX administration
9 Code Sepsis Implementation Timeline Date February 2012 April 2012 November 2012 February 2013 March 2013 April 2013 July 2013 August 2013 Event Initial Kaizen Code Sepsis implemented in non-critical care units Second Kaizen (addressing critical care patients) Surgical ICU Code Sepsis pilot program Implementation in the Emergency Department Implementation in remainder of Surgical ICUs Implementation in Coronary Care Unit Implementation in Medical ICUs
10 Results: Process Metrics Mean (±SD) from Code Sepsis page to ABX delivery to floor = 14.1 (±13.7) minutes Metric Baseline Code Sepsis Mean time to ABX administration (non-icus) 396 minutes 51 minutes Mean time to ABX administration (ICUs) 427 minutes 31 minutes EWS 8 generate RR call 39% 80% Sepsis bundle within 1 hr 5% 70%
11 Results: Patient Outcomes Sepsis-related mortality index decreased from 1.65 to 0.8 WFBMC now in top 10 UHC hospitals for this metric
12
13 Keys to Success Support from Medical Center executives Buy-in & enforcement from physician leaders Collaboration and communication No blaming Awesome PI and Nursing Education staff High level of clinical pharmacy practice
14 Continuing Improvement Aligning bundle goals with new Surviving Sepsis Campaign recommendations Changed screening from EWS to hypotension MAP <65 mm Hg Drop in SBP 40 mm Hg Automated alert and documentation tool in EMR
15 For More Information Beardsley JR, Jones CM, Williamson J, et al. Pharmacist involvement in a multidisciplinary initiative to reduce sepsis-related mortality. Am J Health-Syst Pharm 2016;73: Beardsley JR, Zellmer W. Pharmacist involvement in a multidisciplinary initiative to reduce sepsis-related mortality (Podcast). AJHP Voices. November 2015.
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