Agenda FHA Mission to Care HIIN Sepsis Trends and Progress Cheryl - - PDF document

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Agenda FHA Mission to Care HIIN Sepsis Trends and Progress Cheryl - - PDF document

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An Initiative of the Florida Hospital Association Hospital Improvement Innovation Network Surviving Sepsis: How Florida Hospital New Smyrna Reduced Sepsis Mortality September 20, 2018 Agenda FHA Mission to Care HIIN Sepsis Trends and Progress

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Surviving Sepsis: How Florida Hospital New Smyrna Reduced Sepsis Mortality

September 20, 2018

An Initiative of the Florida Hospital Association Hospital Improvement Innovation Network

  • FHA Mission to Care HIIN Sepsis Trends and Progress

Cheryl Love, RN, BSN, BS‐HCA, MBA, LHRM, CPHRM, Director of Quality and Patient Safety and Improvement Advisor

  • Surviving Sepsis: How Florida Hospital New Smyrna

Reduced Sepsis Mortality

– Karen Pittman, RN, Quality‐Clinical Auditor – Fortunata Hansen, MSN, RN, Director of Clinical Improvement

  • FHA Mission to Care HIIN Resources
  • Upcoming HIIN Events and Opportunities

Agenda

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  • Early recognition

– It is important that we educate our communities

  • As many as 87% of sepsis cases originate in the patient’s community

– EMS ‐ First responder training and sepsis alert protocols – In‐hospital ‐ Frequent assessment using established criteria

  • The Surviving Sepsis Campaign Bundle: 2018 Update

– The 3‐h and 6‐h bundles have been combined into a single “hour‐1 bundle” with the explicit intention of beginning resuscitation and management immediately.

  • Measure lactate level.

– Remeasure if initial level is >2mmol/L

  • Obtain blood cultures prior to administration of antibiotics
  • Administer broad‐spectrum antibiotics
  • Begin rapid administration of 30ml/kg crystalloid for hypotension or lactate

>4mmol/L

  • Apply vasopressors if patient in hypotensive during or after fluid resuscitation

What works?

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Sepsis Post‐op Rate

BL O‐16 N‐16 D‐16 J‐17 F‐17 M‐17 A‐17 M‐17 J‐17 J‐17 A‐17 S‐17 O‐17 N‐17 D‐17 J‐18 F‐18 M‐18 A‐18 M‐18 FL Rate 6.84 5.42 5.48 6.29 4.80 3.92 5.98 5.17 3.94 3.78 4.94 4.92 4.65 4.28 4.06 4.01 4.84 4.47 5.27 3.56 5.78 HRET HIIN Rate 4.72 3.78 3.98 3.82 3.84 3.58 3.52 3.75 3.43 3.36 3.74 3.36 3.61 3.37 3.53 3.50 3.91 3.88 3.85 3.38 3.58 # FL Reporting 73 67 68 68 70 70 70 69 69 70 69 69 70 69 69 69 67 67 66 65 63 #HRET HIIN Reporting 1,006 1,097 1,094 1,097 1,116 1,115 1,114 1,088 1,089 1,089 1,080 1,083 1,084 1,017 1,014 1,010 1,009 1,001 1,002 881 855

0.00 1.00 2.00 3.00 4.00 5.00 6.00 7.00 8.00

Rate per 1,000

Source: Comprehensive Data System, September 9, 2018

Overall Sepsis Mortality

BL O‐16 N‐16 D‐16 J‐17 F‐17 M‐17 A‐17 M‐17 J‐17 J‐17 A‐17 S‐17 O‐17 N‐17 D‐17 J‐18 F‐18 M‐18 A‐18 M‐18 FL Rate 154.8 151.2 150.4 141.5 163.7 145.5 150.2 151.9 127.5 139.6 157.1 135.8 150.0 144.7 136.3 149.2 163.4 129.5 135.6 138.9 118.3 HRET HIIN Rate 130.6 115.5 118.5 118.3 129.3 122.8 121.6 120.6 103.8 109.8 113.3 108.1 112.0 113.2 113.0 120.7 130.6 123.8 115.8 118.2 100.3 # FL Reporting 68 72 72 72 72 72 72 72 72 69 69 68 69 68 68 68 66 64 65 64 64 #HRET HIIN Reporting 1,156 1,341 1,344 1,354 1,366 1,364 1,366 1,354 1,348 1,331 1,325 1,322 1,327 1,315 1,289 1,278 1,270 1,260 1,259 1,131 1,107

0.0 25.0 50.0 75.0 100.0 125.0 150.0 175.0

Rate per 1,000

Source: Comprehensive Data System, September 9, 2018

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Hospital‐Onset Sepsis Mortality Rate

BL O‐16 N‐16 D‐16 J‐17 F‐17 M‐17 A‐17 M‐17 J‐17 J‐17 A‐17 S‐17 O‐17 N‐17 D‐17 J‐18 F‐18 M‐18 A‐18 M‐18 FL Rate 238.33 247.00 256.68 267.44 313.77 250.00 287.26 273.22 264.06 313.25 303.03 257.81 299.38 323.67 232.00 306.12 320.65 238.81 254.55 290.80 292.17 HRET HIIN Rate 135.11 205.30 206.44 215.50 255.45 233.00 235.98 234.86 189.33 193.61 173.26 166.27 168.66 200.49 200.90 239.46 204.50 205.11 219.94 231.25 206.43 # FL Reporting 55 56 55 56 56 56 56 56 56 55 55 55 56 55 55 55 53 51 51 50 50 #HRET HIIN Reporting 1,104 1,260 1,262 1,269 1,279 1,276 1,270 1,256 1,250 1,251 1,250 1,245 1,249 1,238 1,222 1,212 1,210 1,199 1,198 1,102 1,074

50 100 150 200 250 300 350

Rate per 1,000

Source: Comprehensive Data System, September 9, 2018

How Florida Hospital New Smyrna Reduced Hospital Onset of Sepsis Mortality

Presented by: Karen Pittman, RN

September 18, 2018

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Our organization Identify sepsis mortality priority Results of analysis Adherence to best practices Effectiveness of actions Barriers Sustainability

Objectives Our Legacy

Judge Bert Fish 1954 Opening Day 1974 74 Bed Tower 2016 Adventist Health System Acquires Bert Fish Medical Center 2018

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Our Trusted Team

332 Doctors 719 Employees 114 Volunteers 112 Beds

Serving Our Community

28,918 ER Visits 5,227 Inpatient Admissions 1,542 Inpatient Surgeries 3,092 Outpatient Surgeries

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Identified Sepsis Mortality as a Priority Results of Analysis

New Florida Hospital acquisition High mortality Staff did not:

Recognize early signs and symptoms Understand best practice treatment options

Limited data available

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Regional Sepsis collaborative Standardization of care Algorithm and checklist Frontline and Physician champions Campus committee meetings Institute “Sepsis Alert” processes Access to data Concurrent monitoring Region report Daily notification to providers

Adherence to Best Practices Effectiveness of Actions

Severe/Shock Mortality 0.0%

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Lack of understanding No sense of urgency “Just one more thing for us to do” Lack of best practice buy‐in Culture challenges Resistance with practice change Frontline staff overload Lack of time Limited participation in practice change strategies

Barriers

Education: Current nurses Physicians Ancillary staff Community New hire orientation Skills fair Continued: Regional sepsis collaborative Campus committee Concurrent monitoring Communication CMO involvement Sepsis champions

Sustainability

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  • Change Packages and Top 10

Checklists

  • Date of Last Septic Event Poster
  • Post‐op Prevention Process

Improvement Discovery Tool

  • Sepsis Podcast
  • LISTSERVs

MTC HIIN Resources

HRET HIIN Website: www.hret‐hiin.org

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  • Webinars and Coaching Calls
  • National Experts
  • Quality Improvement Fellowships
  • Patient and Family Engagement

Learning Collaborative

  • Chasing Zero Infections Series
  • Safety Culture Survey
  • UP Campaign – SOAP UP, GET UP,

WAKE UP, SCRIPT UP

MTC HIIN Resources

FHA MTC HIIN Website: www.fha.org HRET HIIN Website: www.hret‐hiin.org

MTC HIIN Upcoming Events

  • Sep. 21 – Fall Injury Prevention Strategies
  • Oct. 4 – Reducing Diagnostic Errors: Leading Practices
  • Oct. 5 – Readmissions Multi Visit Patient (MVP) Webinar #1
  • Oct. 16 – TeamSTEPPS Check‐in Webinar
  • Oct. 18 – Falls Fishbowl #1
  • Oct. 18 – MDRO Session #1

Check the MTC HIIN Upcoming Events Calendar for details and registration

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HRET HIIN Quality Award Winner

Congratulations, Florida Hospitals! Outstanding performance in driving quality care, safety and value across its network of hospitals

AH AHA Lead A Leader ershi ship Summ Summit HII HIIN Recept Reception, July July 25, 201 25, 2018

HRET

2018 High Performance Award

Florid ida Hos a Hospit ital al Ass Association

In Support of the Partnership for Patients Program

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13 We are here to help! HIIN@fha.org | 407‐841‐6230

State Lead: Kim Streit, FACHE, MBA, MHS, VP, Health Care Research & Information Svcs. Improvement Advisors: Cheryl Love, RN, BSN, BS‐HCA, MBA, LHRM, CPHRM, Director, Quality & Patient Safety Phyllis Byles, RN, BSN, MHSM, BC‐NEA, Clinical Performance Improvement Advisor Dianne Cosgrove, MS, RN, CPHQ, LHRM, Director of Clinical Quality Improvement Communications: Luanne MacNeill, Quality Initiatives Coordinator Data Support: Debbie Hegarty, Manager of Surveys & Special Projects Fellowships & Patient and Family Engagement: Allison Sandera, MHA, Project Manager

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