1. GAPP Coaching Call Sepsis Working Session August 14, 2014 Jan Ratterree Lynne Hall Jean Allred

2. Learn. Act. Improve. Spread. Keep the Drum Beat Going. 2 SEPSIS Bundle Recommendations http://www.ihi.org/resources/Pages/Tools/SevereSepsisBundles.aspx http://www.ihi.org/resources/Pages/Tools/SevereSepsisBundles.aspx The Severe Sepsis 3-Hour Resuscitation Bundle contains the following elements, to be completed within 3 hours of the time of presentation with severe sepsis: Measure Lactate Level Obtain Blood Cultures Prior to Administration of Antibiotics Administer Broad Spectrum Antibiotics Administer 30 mL/kg Crystalloid for Hypotension or Lactate ≥4 mmol/L The 6-Hour Septic Shock Bundle contains the following elements, to be completed within 6 hours of the time of presentation with severe sepsis: Apply Vasopressors (for Hypotension That Does Not Respond to Initial Fluid Resuscitation to Maintain a Mean Arterial Pressure (MAP) ≥65 mm Hg) In the Event of Persistent Arterial Hypotension Despite Volume Resuscitation (Septic Shock) or Initial Lactate ≥4 mmol/L (36 mg/dL): – Measure Central Venous Pressure (CVP) – Measure Central Venous Oxygen Saturation (ScvO2) Remeasure Lactate If Initial Lactate Was Elevated Some bundle elements may not be completed if the clinical conditions described in the bundle do not prevail, but clinicians must assess for those conditions and make a determination. The intention in applying the bundle is to perform all indicated tasks 100 percent of the time within the first 6 hours of identification of severe sepsis. 2

3. Learn. Act. Improve. Spread. Keep the Drum Beat Going. 3 Success.... A total of 9 hospitals (over 50%) have maintained or improved their LEAPT Sepsis mortality data. More than 80% of LEAPT hospitals are compliant with all of the Sepsis bundle measures. Five of the measures were at 94% which shows that our hospitals are putting the best practices in place for prevention of Sepsis mortality. 3

4. Learn. Act. Improve. Spread. Keep the Drum Beat Going. 4 Best Practice Snapshot Sepsis Bundle Implementation Best Practice Survey QuestionsYesNo Implemented a 3hr sepsis bundle for rapid identification and treatment of sepsis including: 3hr: Obtain serum Lactic Acid89%11% 3hr: Obtain blood cultures (minimum 2 sets from separate sites) prior to antibiotic administration94%6% 3hr: Give broad spectrum antibiotics within 1 hour of positive sepsis screen94%6% 3hr: Document initial SBP, MAP, and Lactic Acid89%11% 3hr: Deliver 30ml/kg Crystalloig IV Fluid I SBP =494%6% Implemented a 6-hour sepsis bundle with persistent hypotension including: 6hr: Apply vasopressors to maintain MAP >=6594%6% 6hr: Obtain central venous access and document initial CVP and central venous oxygen saturation94%6% 6hr: Continue resuscitation to achieve CVP >= 8 (12 if mechanical ventilation) and ScvO2 >=70%89%11% 6hr: Measure repeat serum lactic acid if initial value > or = 289%11% 4

5. Learn. Act. Improve. Spread. Keep the Drum Beat Going. 5 Hospital Sharing Successes Roadblocks Plans for National Sepsis Recognition Day September 2014 – September Sepsis GAPP Call: Tammy Gilleland Sepsis Speaker 5

6. Learn. Act. Improve. Spread. Keep the Drum Beat Going. 6 GAPP Updates Mandatory Meeting Attendance – Coaching Call and Sepsis Discussion Second Thursday of month. Must complete an evaluation – If you miss a call you can listen to the recording within 1 week. Complete eval if applicable, and notify topic lead that you listened to get credit. Data Submission: – Due 3 rd or each month – send to Lynne Hall (lhall@gha.org)lhall@gha.org TOC (1 for sepsis and 1 for additional topic area) Checklist (1 per hospital) – Worker Safety Data (if in WS group) Send to Jean Allred (jallred@gha.org)jallred@gha.org due 15 th of month (about 45 days after end of reporting month). Next Coaching Call and Procedural Harm/Failure to Rescue Working Session August 21st, 1 -2 pm 6