project sepsis - uc irvine health...background according to the institute for health improvement and...

Project Sepsis

By: Florence W. Zilko, RN, BSN, CCRN

NK9EOa , Project Sepsis.pdf

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Background

According to the Institute for Health Improvement and the Surviving Sepsis Campaign, severe sepsis carried with it a mortality risk between 30-50%, and in the setting of shock, this rate is even higher.

It is well accepted that building interventions for a disease such that algorithmic responses are carried out leads to better outcomes.


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Background

• Sepsis can harm and kill patients if not treated quickly & increases ICU length of stay and its associated costs.

• Developing a Sepsis Response team protocol will help to identify patients in early sepsis and facilitate sepsis resuscitation bundle utilization.


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Goal of Project Sepsis

To assess the general knowledge of sepsis To promote early identification of a septic

patient To enhance early treatment (by decreasing

the diagnosis to treatment time) To educate the nurses


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Objective Method/Project Component Outcome Measurement

Assess the general knowledge of Sepsis

Design a Questionnaire or survey Pre-test or a Pre Questionnaire

Interview of nurses

Survey sent by email

Diagnose: Promote Early Identification of a septic patient

Formulate a new SBAR – Sepsis screening tool

Completion of screening tool

Overarching goal: Enhance early treatment by decreasing the diagnosis to treatment time

Doing an In service on how to use the Algorithm/Practice guidelines/ Order sets/ Screening tool SBAR Design an educational packet

Post Test

Identify current issues with electronic screening and educate nurses on new process

Meetings with IT

Update Sepsis CBT

Create bedside reference and load to SharePoint

In-services to MICU Staff

Chart audits

Changes made to electronic screening

Completion of Sepsis CBT

Reassess the nurses every 3 months

90% of staff in-serviced


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Pre & Post Survey Questions

1. Which statement most accurately describes sepsis?

2. Which isn’t a clinical sign of systemic inflammatory response syndrome?

3. Which phrase best defines severe sepsis? 4. Which blood test is used to assess tissue

perfusion in a patient with sepsis? 5. Antibiotic therapy for suspected sepsis

should begin


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Pre & Post Survey Questions

6. In the presence of severe sepsis, septic shock is diagnosed when the patients lactate level is

7. The cytokines and white blood cells that are released during sepsis trigger

8. What maybe the first symptom of sepsis noted by clinicians?

9. When fluid administration fails to restore an adequate arterial pressure and organ perfusion, what therapy should be used:

10. What system do we currently have in place for sepsis detection and management?


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SEPSIS RAPID RESPONSE

STUDY PACKET

Sepsis kills up to 50% of those infected.

How many deaths will you prevent this year?


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Comparison of Pre & Post test results


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Post test questions: PROBLEM!

1. Which statement most accurately describes sepsis?

2. Which isn’t a clinical sign of systemic inflammatory response syndrome?

9. When fluid administration fails to restore an adequate arterial pressure and organ perfusion, what therapy should be used:

10. What system do we currently have in place for sepsis detection and management?


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Findings from Post test:

Nursing re-education is needed on: • Definition of SIRS/Sepsis/Severe

Sepsis/Septic Shock • Treatment/Algorithm • Clarification on current process of screening


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Sepsis chart audits:

• Are changes being translated into practice? • Is the system/timing/sequence reliable? • Are the goals of the bundle being met? • Time of blood cultures/antibiotic

administration and lactate orders? • Are they within 1hr in the ICU or 3 hr in the

ED?


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Findings:

• Timely completion of the nursing portion of the sepsis screening task is not being done – There is delay from the time of trigger to the time that the screen is done.

• Inconsistencies in nursing documentation on “documented/suspected infection”.

• Changes made on Simple sepsis screen – Masking the trigger and no supportive documentation


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Findings

• Uncertainty on when Time zero begins . • Clarification was needed on

DNR/DNAR/DNI. • NOT DONE option on the nursing task

creates a 24 hr suppression • Lack of communication/understanding on

purpose of antibiotics • 7 day suppression created if MD only

ordered fluids for treatment


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Plan of Action

• Nursing education to: • Reinforce the importance of screening within

the hour of the trigger. • Define sepsis and the SIRS criteria • Emphasize the need to know your patient. • Create awareness on what systems are in

place for sepsis detection and management.


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Nursing Education

Updated Sepsis CBT to reflect the new electronic screening process

Designed a bedside laminated reference for nurses

In-services given as verbal update on the process

Created Clinical Update to be emailed to all staff outlining the screening process

Continuous random audits to be performed


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Plan of Action

Work with IT to improve the current screening process. The changes include:

MD name and time of notification included as part of the screen

The Sepsis screening tool assessment is now at the top of the work list


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The suspected infection list will be visible before answering the question “ Does the patient have any documented or

suspected source of infection.


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IT changes

• NOT DONE option on the nursing task – will be deactivated since ALL patients are to be screened in a timely fashion.

• Nursing narrative will be included to explain: • Why + SIRS and – SEPSIS? Or if VS were

entered in error or due to pain/movement/agitation


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IT Changes

• Items on 7 day suppression to be re-designed/reworded to include appropriate treatment and management algorithm


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On going…

• Active Sepsis Task Force nursing representative attending all meetings

• Continuously seeking/receiving feedback from bedside nurses on sepsis screening and relaying the information to relevant parties

• Audits on + sepsis screens • Point of contact for sepsis related queries


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Thank you :-)


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project sepsis - uc irvine health...background according to the institute for health improvement and...

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