Sepsis Six A Call to Action in Reducing Sepsis Mortality SSM - - PowerPoint PPT Presentation

Sepsis Six – A Call to Action in Reducing Sepsis Mortality SSM Health St. Mary’s Hospital, Janesville

Kathleen Glenn RN,BSN,MBA VP Patient Services/CNO

• We know that a delay in recognizing and treating sepsis can mean the difference between life & death for our patients.

Situation: Sepsis

Background: A Call to Action

• In the spring of 2012 our mortality rate was at 1.76 upon review of
• ur mortality cases we noted that a one of the patients had been

septic and this was not identified during the patient’s hospital course.

• This was a call to action for us!

A Team approach

• The identification and treatment of sepsis is complicated.
• How do we harness all the knowledge and expertise required to

provide the best care?

• In 2013 our hospital critical care committee assisted in providing
• versight for sepsis improvement.

Assessment: Evidence Based Approach

• Critical Care committee formed and performed literature review,

based on this the following strategies were implemented:

• Developed “Sepsis Algorithm”
• Created paper checklist
• Implemented rapid response protocol and team called “Sepsis Six”
• Performed staff education
• Performed physician education

Sepsis Rapid Response

• Activated by ANY staff member by calling the operator.
• Operator then pages the Sepsis Rapid Response Team to patient’s room.
• Team arrives and assesses patient, screening patient for sepsis, severe

sepsis, or septic shock.

• If the patient does have severe sepsis or septic shock, the rapid response

team assists the bedside nurse in completing the required bundle elements.

• Each discipline takes ownership of things they can control.
• Example: Lab ensuring blood cultures & lactic acid are ordered and collected;

Pharmacy ensuring that a broad-spectrum antibiotic has been ordered and is readily available for nursing staff; etc.

• If the patient does not have severe sepsis or septic shock, care is de-

escalated as appropriate.

Sepsis Rapid Response

• Rapid Response Team Members
• Hospitalist
• ICU Nurse
• ED Nurse
• Nursing Supervisor
• Primary Nurse
• Phlebotomist
• Pharmacist
• Sepsis Coordinator

How do we know we are improving:

• Sepsis coordinator performs concurrent review of patients daily
• Implement a visual “Sepsis Scorecard” with data from each piece of the SEP-1

measure.

• Appropriate cases referred by Medical Directors for Physician Peer Review.
• CDI (Clinical Documentation Improvement) review of all sepsis cases to

ensure the appropriate risk of mortality is documented in the medical record.

• Recognition letters for exceptional care sent out to individual staff members

and their respective leaders.

• Sepsis case studies presented at staff department meetings.

Tools Developed

Recommendation

What have we learned?

Lessons Learned: One and done, is not Done!

• One rollout of sepsis education in 2013 was not enough.
• Opportunities identified after initial roll out:
• Lack in data collection
• Inconsistencies in rapid response use
• Roles and responsibilities of rapid response members not clearly defined
• Resistance from hierarchy
• Lack of structured feedback to clinicians on sepsis cases
• Formal recognition did not exist

Sepsis Mortality Rates

1.76 1.34 1.3 0.72 0.52 0.23 0.69 0.2 0.4 0.6 0.8 1 1.2 1.4 1.6 1.8 2 2012 2013 2014 2015 2016 2017 2018 Sepsis Mortality

Sepsis Coding

7 12 12 8 9 8 9 11 11 8 9 10 10 10 10 8 2 3 5 4 4 8 5 5 6 6 6 7 0.00% 0.00% 10.00% 10.00% 20.00% 20.00% 30.00% 30.00% 40.00% 40.00% 50.00% 50.00% 60.00% 60.00% 70.00% 70.00% 80.00% 80.00% 90.00% 90.00% 100.00% 100.00% 10 10 20 20 30 30 40 40 50 50 60 60 70 70 80 80

• St. M
• t. Mar

ary's Hos

• spita

pital l - Jane anesville ille Sever ere S e Seps epsis is/Septic eptic Shoc hock k Cas Cases es

Ca Case ses Meeting SEP-1 Co Coded with R65 R6520-1 % % Wi With R6 R6520-1

Sepsis Best practices

• Standardize approach to Sepsis.
• Sepsis scorecard.
• Dedicated Sepsis Coordinator reviews cases concurrently and retrospectively.
• Sepsis Rapid Response Team – all staff are empowered to call when patient meets criteria. Team members have

designated roles.

• Checklist created for Physicians to ensure all bundle requirements are met and documented.
• Root Cause Analysis performed on all outliers, opportunities to improve are identified and communicated.
• Peer review for outliers.
• Monthly case studies shared at all department and Hospitalists meetings.
• CDI review of all Sepsis cases with appropriate queries to capture severity of Sepsis.
• Lessons learned shared monthly hospital wide.
• Recognition for exceptional care.
• Timely Palliative Care consults for goals of care conversations.