Identifying and Tackling Sepsis in Healthcare Tuesday 25 th April 2017 Working in partnership to improve the identification and treatment of sepsis Tracy Broom Associate Director Wessex Patient Safety Collaborative Wessex Patient Safety Collaborative Connecting and sharing across Wessex to improve patient safety
Working in partnership to improve the identification and treatment of sepsis A focus on sepsis; our journey from decision to delivery Forming collaborative teams Outlining the successful initiatives that emerged What we learnt across the 12 months about collaborative working Sharing progress the onward road
Wessex AHSN is a member led organisation: 5 Universities [Bournemouth, Southampton, Winchester, Portsmouth, Solent] 10 Clinical Commissioning Groups [CCGs] 11 NHS providers acute / community & mental health and combined
The aim of the PSCs The 15 Patient Safety Collaboratives aim to improve the safety of patients and ensure continual patient safety learning sits at the heart of healthcare in England. The PSCs are borne out of Professor Don Berwick s report, A Promise to Learn a commitment to act which called for the NHS to become, more than ever before, a system devoted to continual learning and improvement of patient care, top to bottom and end to end. Local engagement through structured quality improvement initiatives Building system-wide capability for both staff and patients in quality and safety improvement Local systematic spread of quality improvement outcomes across health and social care Networking between the AHSNs and their partner organisations and stakeholders to ensure the optimal spread of locally developed solutions & interventions Active contribution to national sharing and learning
A focus on sepsis: Our journey from decision to delivery
Local (Wessex) Patient Safety Priorities [Nov 2014]
Ideas Will Execution Institute for Healthcare Improvement [IHI] Breakthrough Series [BTS] Programme
Topic and Method a wrap around concept Improvement Team Diagnostics SEPSIS AKI Falls Tasks Testing using the Model for Improvement
Wessex PSC Methodology for our sepsis work Adapted from The Institute for Healthcare Improvement (IHI) Breakthrough Series Model Pre-Work Set improvement goals, collect baseline data and prepare for Learning Event 1 Learning Event 1 Action Phase 1 A P S D Learning Event 2 Action Phase 2 A P S D Learning Event 3 Action Phase 3 A P S D Learning Event 4 On-going support Webinars and phone calls Use of the LIFE platform and PDSA review Project Manager meetings Site visits
The Model for Improvement
Forming collaborative teams
We had 12 sepsis improvement teams working in the Collaborative: Basingstoke and North Hampshire Hospital Dorset County Hospital Portsmouth Hospital Poole Hospital Royal Bournemouth and Christchurch Hospitals Royal Hampshire County Hospital - Winchester Salisbury Hospital Southampton Hospital Lymington Hospital community Dorset CCG West Hampshire CCG Paediatric Critical Care Network [Wessex and TV]
From ward to board From ward to board
Each improvement team had: CEO sign up and support An Executive Sponsor A Clinical Lead A Project Manager The Away Team Members The Home Team Members
Outlining the successful initiatives that emerged And What we learnt across the 12 months about collaborative working
Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Wessex Patient Safety Collaborative Connecting and sharing across Wessex to improve patient safety University Hospitals Southampton have worked alongside the Wessex PSC sepsis BTS since June 2015. Since then we have developed an adult, paediatric and maternity sepsis screening tools all of which have been through multiple PDSA cycles. We have implemented the adult and paediatric screening tools into our electronic system within ED thus producing an increase in screening from 3% in July 2015 to 100% in December 2016. Development of a sepsis team - ICU consultant clinical lead for sepsis, Band 7 sepsis clinical nurse specialist, Band 6 sepsis clinical nurse, data analyst. Roll out of new clinical escalation form for all adult inpatient areas. Electronic alert for antibiotic review by day 3 on Doctors Work List. April 2016 - December 2016 Trust wide percentage success 100% 80% 60% 40% 20% 100% 80% 60% 40% 20% 0% Trust Wide - Percentage Success from July 2015 - December 2016 Admission areas screening Admission areas antibiotics Inpatients screening Inpatients antibiotics 0% Apr May Jun Jul Aug Sep Oct Nov Dec Percentage of patients that were screened Percentage of patients that received antibiotics within the target time frame UHS Sepsis team, Emma Hodgson, Dr Dominic Richardson and Julian Wright.
Achieving our aims through Collaboration Key achievements Developed a screening tool Viral spread of the message through the organisational meeting structure Sepsis Steering Group Antibiotic Reference Group Safety Steering Group AKI Working group Drip feeding the message through training 168 nurses and AHP s attended training sessions in 2016 Celebrating success in the Emergency Department In May 2015, 17% of patients were screened and 36% of patients received antibiotics within 60 minutes In November 2016, 98% of patients were screened and 85% of patients received antibiotics within 60 minutes Key take home messages from the Salisbury Sepsis Team Start small to keep it manageable remember you have a day job When the run chart is going in the wrong direction, look for your successes to motivate you The hard bit is getting the boulder moving, once you build momentum it will move itself The Critical Care Outreach Team Celebrating Sepsis Awareness Day October 2016 Celebrating Team Work March 2016
Wessex Patient Safety Collaborative Connecting and sharing across Wessex to improve patient safety Nationally 28% of patients with severe sepsis were receiving antibiotics within one hour. Poole Hospital Emergency Department audit showed exactly the same Poole joined the AHSN o Developed and introduced a new screening tool using NEWS and red flag features o Introduced a simplified antibiotic policy o Updated admission paperwork throughout the trust o Intensive simulation training in ED using sepsis scenario o Support from new role of Sepsis nurse In July 2016 in Poole ED 95% of patients presenting with sepsis received antibiotics within one hour. This position has been maintained Feb 17 91%. In January 2017 for the first time 100% of audited in-patients with red flag sepsis received antibiotics within 90 minutes. I was a Consultant, now I am a Consultant who understands Quality Improvement Dr Fran Haigh, Anaesthetist
Q8 We would like to understand at the end of the event if your knowledge, skills and confidence levels have changed from your pre event levels 100% 80% 20 6 7 3 12 13 6 11 9 4 60% 40% 20% 0% 28 26 17 18 17 36 23 30 26 25 39 43 37 40 9 19 17 21 3 10 10 17 8 20 13 19 SL Confidence SB Confidence MB Confidence SL Skills SB Skills MB Skills SL Know (Same) SB Know (Slightly Better) MB Know (Much Better) 202 individuals in 22 teams from 13 organisations Sepsis and Transfers Collaborative
Get your chefs of all levels together in the kitchen, agree the recipe and work collaboratively Use a good recipe that all the chefs understand Test and taste the recipe until its good to go Make sure you add the right measure of patient at the start not at the end of the bake A suggested list of tools and techniques to make a great recipe Ensure your head chef is supportive and keep them updated on kitchen progress Small and often makes a big difference Learn from others what works well and what doesn't. Then bake a cake that works for your diners Start small and build your menu as you learn Measure your ingredients carefully using small data, this is time well spent and will effect your bake. Review often to check the cooking progress.
Sharing progress the onward road
2015/16 2016/17 Sepsis BTS Sepsis Network Physical Deterioration BTS C O M M U N I T Y Newsletter Conference LIFE platform 2017/18 DetSep Network Primary Care Outreach S I P Conference CSIP
Contact details: patientsafety@wessexahsn.net http://wessexahsn.org.uk/programmes/21/patientsafety-collaborative 023 8202 0844 @tracypsc @wessexpsc @wessexahsn #saferwessex Wessex Patient Safety Collaborative Connecting and sharing across Wessex to improve patient safety