Ronán O Cathasaigh Mayo University Hospital

Mayo University Hospital Part of the Saolta University Healthcare Group Acute care to Mayo and parts of West Roscommon, North Galway and Sligo Population of 130,552 306 in-patient beds 51 day beds 34,192 ED admissions in 2014 214 ICU admissions in 2014

Patient TM 1200: BIBA to ED from Home Increased confusion, pyrexia and dyspnoea 1207 ED triage: Category 3 1222 ED NCHD 1232 IV fluids and oxygen 1244 1st dose of IV antibiotics 1250 Bloods sent including lactate & cultures Fluid balance chart commenced 1300 Referred to Medical team Discharged home after 6 days

How did we get here? Natural progression from implementation of NEWS 2012 Incidents of late identification and management of Sepsis in ED identified a need for improvement

ICU admissions 2012 2013 933 797 14.5% reduction in ICU admissions in 2013 Highest reduction in admissions from ED (↓21%) Mostly due to implementation of NEWS 11% reduction in Sepsis admissions to ICU in 2013

Implementation of Sepsis National Clinical Guideline Introduced in December 2014 National Sepsis Lead Visit NEWS Governance Group extended to include Sepsis Lessons learnt from NEWS implementation

Governance Combined NEWS and Sepsis Group Driven by HMT Terms of Reference adapted. Amendments to existing hospital policies Incident review template extended to include sepsis

Education Collaboration with NCHD leads Ward based training Grand rounds Weekly scenario-based training Departmental meetings

Education Specific sepsis presentations for Medicine ED Anaesthetics Paediatrics Obstetrics

Sepsis Documentation Remains challenging Auditing Who completes the sepsis screening form?

Incident Management Incident reporting template Specific learning Feedback to all stakeholders Identification of trends

Incident reporting

Auditing Share the workload Students Antimicrobial Pharmacists Practice Development Develop audit tools that will produce useful data

Audit Findings Sepsis documentation Compliance with Sepsis 6 Antimicrobial Stewardship ICU admissions Feedback provided Action plans Quarterly newsletter

Audit Findings Reduction of 6.9% in patients with Sepsis requiring ICU admission Reduction in ALOS by 3 days (Ref: HIPE, Health Pricing Office & ICU data)

World Sepsis Day Local media involvement 350 attended the event Staff, patients, relatives and members of the public. Presentation of audit findings Promotion of achievements

Recognise your successes Feedback to staff Newsletter MUH Quality & Patient Safety Symposium National Patient Safety Conference International Forum on Quality and Safety in Healthcare, Gothenberg 2016

The future Development of Group policies Blended learning Sepsis e-learning module Auditing Pre-hospital/Primary care training Public education

Future Challenges Sustaining progress to date Documentation Auditing

Innovation Could we save 150 lives in 150 days?

Innovation

Sepsis 6- How hard can it be….? The Sepsis 6 bundle is derived from the Surviving Sepsis Campaign evidence-based Guidelines for management of Severe Sepsis (Delinger et al., 2008). Derived from 24 hour and 6 hour bundles. 23

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