1. Aurora Medical Center - Oshkosh Friday, June 2nd 2017
Improvement Action Network (IAN)
Sepsis
Aurora Medical Center - Oshkosh
Friday, June 2nd 2017

2. Agenda

3. Round Robin – Gap Analysis and Goals
Each hospital team reports off on the completed gap analysis and goal to accomplish today.

4. Aurora Medical Center Oshkosh
Improvement Action Network
SEPSIS
June 2, 2017

5. Aurora Medical Center Oshkosh
84 bed progressive community hospital
24/7 emergency services
Level III Trauma Center
Level II Special Care Nursery
On-site specialties and tele-services
e-ICU; tele-stroke; tele-psych
Primary Stroke Center Certified (TJC)
Nationally Accredited Breast Center (NAPBC)
Accredited Cancer Program (Commission on Cancer)
Accredited MRI, CT, Ultrasound, Mammography, and Stereotactic Biopsy (ACR)
Accredited Echocardiography program (IAC)
Accredited Wound/HBO program – Level II with distinction (Undersea & Hyperbaric Medical Society)
National recognition for quality (QUEST) 2016
Blue Distinction for Hip/Knee Replacement 2016
Blue Distinction for Maternal/Child care 2016 (invited to apply-2017)
Get With the Guidelines recognition for Heart Failure
Gold Plus Get With the Guidelines for Stroke 2016
National ranking as safe hospital 2014
Truven™ Top 100 Small hospitals 2015, 2017
84 bed progressive
community hospital
located in east
central Wisconsin;
Opened Oct 23, 2003
AMCO has an avg of 20 sepsis primary or secondary coded patients per month. 1 to 3 develop sepsis as an IP the rest are admitted through the ED.
Our ICU has 12 beds, our Medical Surgical units each have 17 beds.
TJC = The Joint Commission
NAPB = National Accreditation Program for Breast Centers
ACR = American College of Radiology
IAC = Intersocietal Accreditation Commission
Quest = Premier hospitals

6. Aurora Medical Center Oshkosh
Presentation will include:
SEP-1 SBAR
3 hour bundle elements
Successes
Opportunities
Caregiver Roles
Aurora System Sepsis Groups
Oshkosh PI tools and data
Read through bullet points

7. SBAR Situation Background Assessment Recommendation
S: SEP-1 is announced as new Core Measure by CMS B: The evidence cited for all components of this measure is directly related to decreases in organ failure, overall reductions in hospital mortality, length of stay, and costs of care A: Caregivers must recognize severely septic patients early and treat them urgently R: Learn severe sepsis criteria and BLAST sepsis
Read through SBAR points one by one

8. Focus: Early Management Bundle 3 Hour Bundle Elements for Severe Sepsis/Septic Shock
Initial Lactate Level Collection
Broad Spectrum or Other Antibiotic Administration
Blood Culture Collection
Read 3 hour bundle elements
Describe BLA then S and T

9. Successes
Head start on Sepsis information foundation due to Readmissions group spin off
BLAST
Leadership attendance
Real Time abstraction and reporting results for no delays in improvements
Quality Provider
Sepsis report out Quarterly at Department of Emergency Medicine meetings
AMCO SEPSIS web page
Invitation to Sepsis IAN
In November of 2015 Vicky McCann QIC and Linda Backus Care Coordination Supervisor collaborated and discovered that Oshkosh was having frequent readmissions—not by core measure patients like CHF and AMI, now we were seeing COPD, Alcohol abuse, GI/GU, and sepsis patients. Sepsis was originally a sub-group of this Readmission Workgroup; however once sepsis became a core measure we created a Sepsis Workgroup. READmission target rate is 13.2 for sepsis we are at 10.2 % as of January 2017.
BLAST was introduced to the Sepsis workgroup by Dr. Newman our Hospital President. It is an Acronym that quickly reminds caregivers of the bundled elements.
Our workgroup membership consists of Risk, unit supervisors, Nursing Leadership, our Quality Physician, and Dr. Newman. They are charged with sharing the workgroup’s information with their staff.
4. Weekly real time random cases are abstracted and results are sent to Caregivers and their “bosses”. Teaching tool for SEP-1 specifications and opportunity for questions. Monthly Premier abstraction for SEP-1. each result grid is sent to caregiver with the Pass or Fail.
We now have a Provider, Dr. Prehn, that specializes in Quality and attends our meetings.
Frontline Caregivers for SEP-1 are the ED Providers. I am allowed time to report out on our Monthly results and Sepsis Mortality rates.
Our web page houses links to Sepsis meeting information and links to the System Sepsis web page and hyperlinks to the Think Katie First YouTube video
One other Sepsis metric that the Aurora system monitors is Sepsis LOS target of as of January 2017 = 4.22.

10. Opportunities Communication iSTAT Lab
Broad spectrum antibiotic order of administration
Timing misses
Omissions
1. Communication is the key to urgent treatment for severe sepsis patients. ED RN’s can drop Ordersets in triage to start lab draws and screen the patient documenting a suspected infection. Communicating findings to the provider helps faster order placement for Blood cultures and antibiotics, crystalloids etc.
We started using iSTAT or Point of Care testing in the ED in September of Istat results lactate in 5 mins vs. 45 mins. Challenges are faster results prompting faster order entry for faster treatment. Also TJC requires critical test result documentation of communication to Provider in 60 mins or less. We are also monitoring that the istat criticals are documented.
When there is a timing miss for a lab result I drill down to the actual order time, who collected the blood and reach out to the lab supervisor for support.
Order set use drives the best practice treatment of the severely septic patient. The measure specifications require the correct antibiotic choice and administration within 3 hours. Aurora Health Care Summit shared a pharmacy written compatibility chart that shows safe concurrent and or which to give first when 2 are ordered. i.e. broadest first then Vanco.
Due to delays from moving the patient from ED to IP, we missed measures by minutes. E.g. delays from order releasing, that cause delays in lab draws.
Early on we were missing on blood culture ordering for the 3 hour bundle in the ED. 6 hour bundle misses include the repeat lactate and repeat volume status assessment for pt’s with a lactate >4.

11. Providers Enjoy research results to justify action
Ordersets: short and minimal clicks
Demo EPIC sepsis order sets, flow sheets, smart and dot phrases
Ask their preferred method for reminding them of measure requirements
Effective feedback method
Mortality results for sepsis coded patients
Sharing study results helped with provider buy in.
Prefer not to use the order sets. Tried to design them and made revisions to simplify their use.
As tools are improved upon and developed our Providers are alerted.
At the first sepsis workgroup meetings, I asked the hospitalists what their preferred method for reminders was. They liked the pocket cards created and revised at the system level. So I had them laminated and handed them out including in the ED.
Initially I shared report results from the system based on data that was 2 months behind . I was given the ok to stop abstracting all sepsis patients and went down to 10 per month for CMS/Premier. This allowed for more real time feedback. Now I complete 1 to 2 sepsis patients per week. This way the caregivers can recall the patient. Feedback via grids-real time and for the measure What is necessary to pass Why fail? PASS! How?

12. RN’s Defining Severe Sepsis and Septic Shock Sepsis Screening
Communication with Providers
RRT
BLAST
Labs
Broad Spectrum Antibiotic order of administration
MAR accurate documentation
SIM man used by Med Surg educator
Sepsis Checklist from ED to IP
And 2 go together. So, Our Risk team asked to join the Sepsis workgroup in They had a sepsis patient that had a bad outcome. They asked how the nurses could better identify patients that were becoming severely septic. I was able to share the sepsis screening tool that Aurora System had developed. Risk wrote an action plan and collaborated with the nursing unit supervisors. Going forward RN’s were expected to screen all patints upon admission and twice a day thereafter. The screening tool has a calculator that when the patient meets the CMS severe sepsis requirements they screen positive. This prompts the RN to alert the provider. There is a place to chart documentation of this communication on the screening tool. This is a key way that the RN’s and Providers are learning the severe sepsis criteria. .
Nurses are alerting Providers when severe sepsis is suspected. The providers then place the 3 hour bundle orders or a modification of them if the pt. has been IP.
Nurses are encouraged to call an RRT if necessary. This gets lab to the patient and in the case of a Med Surg. patient the ICU nurse responds. Then the patient can be packed up and transferred faster.
Nurses need to release the orders ASAP. Some fallouts wee due to the delay of the release and how lab processes orders.
If sepsis order sets are not used, the RN needs to use the antibiotic chart to give the antibiotics correctly.
If it isn’t charted it hasn’t been done. This affects crystalloids the most.
Nursing educator Kelly Nagorny recognized that the Med Surg RN’s needed a better understanding of sever sepsis and arranged to use a Sim man to teach about Severe sepsis, Screening, BLAST, and providing the best care for our patients. Kelly also recommended creating an algorithm for sepsis like we have for AMI pat’s.
The ED has a Sepsis Champion. We chatted and she developed an algorithm for the nurses to follow and started using the sepsis checklist in the ED. This lets the IP nurse know what else needs to be done for the patient in order to pass the measure.

13. System Sepsis Committee
Sepsis Community
14 Site Representation
Providers, RN’s, Abstractors
PI sharing
EPIC changes to conform with CMS changes to SEP-1 specs
EPIC reports and support features for sepsis
Monthly meetings are held.

14. Aurora Abstractor Support
Weekly meetings to discuss cases
Discussion of Specification interpretation
Q-net query result sharing
Validation result sharing
AMCO and Baycare share Sepsis meeting information.
SOT documents are a resource for new abstractors to use for consistency between hospitals.
Baycare and AMCO share some ED providers, we share results and support each other.
e.g. Checklist and algorithm Patient Education Project

15. AMCO Sepsis PI New Nurse Orientation
ED PI goal: antibiotic given in <60 mins from time zero
Provider EPIC Education via CIE
ED and IP Preceptor teaching by example
ED and IP champions-handover checklist
Manual abstraction monthly to weekly
Real time results
Meetings monthly to quarterly
Reports monthly to supervisors
Quality Risk and Safety Committee-quarterly consent agenda item report out
Less frequent meetings allows for more real time abstraction and improvement work.
Area Coordinating Council vetting

16. AMCO Sepsis Workgroup Agenda

17. Weekly real time random cases are abstracted and results are sent to Caregivers and their “bosses”. Teaching tool for SEP-1 specifications and opportunity for questions.
Monthly Premier abstraction for SEP-1. each result grid is sent to caregiver with the Pass or Fail.
Monthly Sepsis Screening Tool results sent to IP and ED leaders.
Monthly ED PI result after Premier abstraction is completed sent to ED leaders.
“Sepsis” Mortality report reported out for QRS; and quarterly at Department of Emergency Management and at the Sepsis Workgroup Meeting.
Monthly System Sepsis goal comparison to AMCO results.

18. SEP-1 Grid for Pass or Fail Communication to Caregivers and Providers RANDOM weekly
MRN  xxxxxx    ADM  4/26/2017
PASS
Sepsis Screening Tool used ED xxx,xxxx Y
Sepsis Screening Tool IP ICU
Not yet
Severe Sepsis
Time zero=0944  
Initial Lactate Level Collection  Dr. xxxx, xxxx.
POC  y   critical lab documentation  y y
Broad Spectrum or other Antibiotic Administration Dr.xxxx,xxxx.
Met selection y   met timing y   met ED PI goal of <60 mins y
Blood Culture Collection Dr.xxxx,xxx
Repeat Lactate Level   Dr.xxxx EICU
Was initial  Hypotension present
Septic Shock present   includes Lactate >4
Crystalloid Fluid Administration Dr.xxxx,xxxx.xxxx.
30ml/kg required   2250          received 2500
Vasopressor Administration Dr. xxx,xxx
Repeat Volume status  Dr. xxxxxx
All of the following:
Vital Signs Reviewed
Cardiopulmonary Evaluation
Capillary Refill Examination
Peripheral Pulse evaluation
Skin Examination
OR any 2 of the following:
Central venous pressure measurement
Central venous oxygen measurement
Bedside cardiovascular Ultrasound
Passive Leg Raise or Fluid Challenge
I was able to call and remind the RN to complete the sepsis screening tool.
The E-ICU provider ed me back shortly after I sent the grid and noted that the CVP that had been ordered with the repeat lactate was missing. I called the RN with a gentle reminder after I thanked her for doing such a great job caring for this patient.

19. February 2017 results Premier Pass or Fail
5/10 included
5/5 Fails
3/5 started in ED but missed as IP
IP-Initial lactate not drawn
IP-No repeat lactate level
IP-Not all elements of Reassessment of Volume Status and Tissue Perfusion were completed in time window beginning at Crystalloid Fluid administration and ending 6 hours after Septic Shock Presentation
No peripheral pulse documentation x2
No Repeat volume status documentation
MRN  xxxxxxx                                  ADM 2/12/2017
FAIL
Initial Lactate level not drawn in time window between 6 hrs. prior to and 3 hrs. following Severe Sepsis Presentation
Initial Lactate drawn more than 6 hrs. prior to Severe Sepsis Presentation
Initial Lactate drawn more than 3 hrs. after Severe Sepsis Presentation
No antibiotic was administered intravenously 24 hrs. prior to 3 hrs. following Severe Sepsis Presentation
Antibiotic administered more than 3 hrs. after Severe Sepsis Presentation
The IV antibiotic given within 3 hrs. following Severe Sepsis Presentation is not consistent with antibiotic selection guidelines
Blood Culture not collected in 48 hrs. prior to 3 hrs. after Severe Sepsis Presentation
Blood Culture collected more than 3 hrs. after Severe Sepsis Presentation
Antibiotic administered prior to Blood Culture collection
Repeat lactate level not drawn in time window from Severe Sepsis Presentation to 6 hrs. after Severe Sepsis
Presentation or UTD or not drawn because no initial lactate level drawn
Repeat Lactate drawn more than 6 hrs. after Severe Sepsis Presentation
Crystalloid Fluids administered but volume ordered was less than 30 mL/kg or UTD volume ordered
Crystalloid Fluids not administered or UTD whether or not they were administered
Crystalloid Fluid Administration was initiated more than 3 hours after Septic Shock Presentation
Patient was not given intravenous vasopressor after Septic Shock Presentation and was not receiving vasopressor at time of septic shock
Patient was not assessed for persistent hypotension or new hypotension within 1 hr. after conclusion of crystalloid fluid administration
Not all elements of Reassessment of Volume Status and Tissue Perfusion were completed in time window beginning at Crystalloid Fluid administration and ending 6 hours after Septic Shock Presentation x
no peripheral pulse exam
In order to Pass in Premier, each sampled patient must meet all of the required elements. For the grid example above on the left, the Septic Shock patient met all of the elements except for the documentation of peripheral pulses therefore the patient FAILED. The provider is ed this result.

20. SEP-1 Areas Of Opportunity Preliminary 4Q16 Data as of 3/15/2017
Aurora system
AMCO
Monthly reports are sent to all of the Aurora hospitals.
Aurora System Sepsis Team decided to use the above data results to target frequent misses and to set an improvement goal. Improvement by 3% is expected.
The x’s denote the 3hour bundle misses for AMCO. Data as of April we had a zero % pass rate.

21. ED PI Goal Antibiotic administered in <60 mins
January 2017 n=3
1/3=33% 
February 2017
3/3=100%
ED chose this goal that drives a reduction in mortality by administering the antibiotic ASAP.
Mortality increases by 7.4% for each hour that passes thereafter.
A new challenge for this goal is that the istat is resulting the lactate rapidly i.e. <10 mins ISTAT vs. 45 mins LAB.
Communicating to the Provider is critical in order to prompt antibiotic ordering sooner.

22. Sepsis Screening Tool Use Rates by area
ED needs to document their screening tool use more often!
IP recovered from their dip in March.

23. IP Sepsis Screening Tool Use
The graph on the left shows that 92% of the time an admitted patient is screened for sepsis. The chart on the right indicates that for April ICU was responsible for the fallouts.
For 2016 I had been manually abstracting the sepsis screening tool use and using Verge completed audits and ran reports. Now Aurora has a CMS Sepsis PI report that captures the bundled elements, screening tool use, and caregivers involved.

24. Target rate of 4.8
After 7 months, AMCO has a drop in Mortalities…This equates to 3 deaths per month for 7 months down to 1 in April. (as of May 26th ) there were 2 mortalities both met the 3 hour bundle, 1 met the antibiotic in <60 mins goal 1 missed it by 40 minutes.
IP’s that expired: Jan 0/3 Feb 1/4 March0/3 April 1/1 May 0/2
IP Sepsis screening twice a day every day and upon admission is an AMCO expectation for early identification and urgent treatment. If you don’t screen for it you won’t find it. IP’s that develop severe sepsis have a higher risk for mortality. Both May mortalities were screened by ED and IP as expected.

25. AMCO Sepsis Web page

26. New Sepsis Endeavors for AMCO
Sepsis checklist / hand over form from ED to IP
EPIC changes to include checklist items concurrently on Sepsis Screening Flow Sheet pop-up box/index report
Readmission Committee - sepsis and sepsis /pneumonia cohort
Patient Sepsis Education Folder
Community Sepsis Education
Mock code scenarios may include Sepsis
WHA Simulation Scholarship for Sepsis
RN champion from ED is spearheading this process. Goal: Improved Communication about what was completed in the ED and what still needs to be met for SEP-1 after transfer.
This concurrent EPIC report will highlight sepsis specific labs, SIRS criteria, and 3 and 6 hour bundle elements
AMCO’s Readmission committee is doing small tests of change on a patient call back process that will in the future include clinical sepsis questions.
Patient sepsis education folder is being created by a System sepsis sub-group headed by Sheila Hess at Bay Care.
I am hosting an information table for Sepsis education at the Aurora Oshkosh Vince Lombardi Cancer Walk
On May 23rd a mock code was held in the FonduLac Oncology Clinic with a sepsis scenario. Dawn Schram, RN Educator discovered a gap in Sepsis education. During the code the team thought about the possible causes: dehydration, infection-probably septic. The team was unaware of the BLAST acronym.
7. We won the scholarship and will be sending a team of bedside caregivers, members of the Sepsis team, educators, an ED Provider and a Hospitalist in September.

28. Mortality Review Committee Found
Sepsis
Surgical
CHF
Pneumonia

29. Compared Nationally ThedaCare Regional Medical Center - Appleton
Sg2 Key Metrics
Lagging Performers
Standard Performers
Top Performers
ThedaCare Regional Medical Center - Appleton
Mortality Rates
DRG 870
> 44.4%
33.3%
< 22.2%
42% Standard- Almost lagging
DRG 871
> 24.8%
21.1%
< 14.5%
24% Standard- Almost lagging
DRG 872
> 5.7%
3.8%
< 2.0%
3.6% Standard
Sg2 is a third party analytic company that we pay to provide us data so that we can better allocate our resources. One of the services they provide us is comparative statistics. This table shows that in two of the three sepsis DRGs Appleton Medical Center is just better than a “lagging performer” in regards to sepsis mortality. This is important because sepsis is the number one cause of mortality nationally in non-cardiac ICUs and more relevantly in both AMC and TCs ICUs. These patients are usually the sickest patients in the hospital. They have the longest length of stays and the highest cost per case, which may be justified if we were improving their conditions. But we are not, these patients far too often do not survive as you can see by their mortality rates.

30. How Do We Improve?
• Early Diagnosis - Facilitate early and accurate diagnosis
• Treatment - Ensure appropriate and timely use of treatments and interventions via consistent
clinical protocols.
The Surviving Sepsis Campaign is a joint effort of the SCCM and the IHI. Their initial recommendations were published in March 2004, with subsequent editions published in 2008 and late 2012.
Early diagnosis and timely, appropriate treatment are the cornerstones of the campaigns recommendations. Similar to the care of heart attack, stroke and trauma patients, delays in diagnosis need to be minimized or eliminated and the consistent use of evidenced based best practice needs to be facilitated.

31. Timing Critical to Reduce Sepsis Variation
Sepsis Too Often Still Flies Under Radar, Leading to Increased Mortality
Impact of Compliance with 6-hour Barriers to Early Detection
Sepsis Bundle of Hospital Mortality
Subtle symptoms often fly under the radar
89% increase in risk of death
if patient does not receive Floor nurses not exposed to many Sepsis cases
six hour bundle
Nurses reluctant to sound alarm because of false
positive
All Clinicians extremely busy
Not compliant Compliant
with 6-hour bundle with 6-hour bundle
55%
29% 1
1 hour
Delay in
Antimicrobials
7.6%
Increase in
Mortality

32. Early Diagnosis
To accomplish early recognition of sepsis we leveraged our electronic medical record to assist in the screening process. We built a Best Practice Advisory, or BPA, that acts like a pop-up when the nurse or physician opens a patient’s chart that meets SIRS criteria. When the BPA tells them the patient meets SIRS criteria, they need to decide whether or not the patient has infection and pick the appropriate response to satisfy the BPA. This BPA fires for all nurses, physicians and mid-levels. A similar strategy using EPIC to assist in the screening of sepsis patients has been utilized by UC-Davis for the past 5 years with positive results.
We all have been around alarms that go off so often that they no longer trigger the desired effect in an individual. A priority design goal in creating, and now improving upon, this screening tool was to minimize alarm fatigue. If this BPA becomes white-noise, it is not only no longer serving it’s purpose, but taking critical time away from our practitioners.
In the weeks since go-live the BPA has fired on patients per day at AMC, including the ED of these have been new patients every day. This number has become more manageable, but I feel we still have room for improvement.

33. Appropriate Treatment
Sepsis ED
Sepsis
Floor
Sepsis
ICU
After early diagnosis, appropriate treatment is the next step in effective patient management. This treatment was outlined in the SCCMs recommendations and formed the backbone of three new order sets built by our team. The provider has access to these order sets directly from the BPA. One for the ER, the ICU and floors. Previously, only an ICU order set existed. These order sets are based on the campaign’s guidelines and bundles which, when used appropriately, have been shown to improve patient outcomes. Our aim was not to create cookie cutter medicine but to give providers the right tools at the most opportune time to assist them in their practice.
I think some of our largest gains will come from use of the floor order set. Implementing these proven guidelines with patients in early sepsis will prevent patients from further deterioration, from developing severe sepsis and septic shock which carry such high mortality rates.

34. Alarm Fatigue Nursing productivity Physician buy-in Jacob
Pugliese, 2014

35. Loads of Study Adjust Changed the BPA to decrease alert fatigue
Created a nursing protocol to speed up lab draws
Changed the provider paradigm to order antibiotics off of H&P and not definitive imaging
Nursing/Provider champion role developed in the Appleton ED

36. New Process Metric
80% of septic patients present to the Emergency Department first and evidence suggests every 60 minute delay in antibiotic delivery results in an increase of 8% risk of mortality. The New Goal: Antibiotics within 60 minutes of recognition of sepsis in the ED

37. Improvements – ED Nursing BPA
Brandi

38. The importance of engagement and talented local leaders can not be over emphasized

39. Continue to Study and Adjust to Improve Patient Care

40. Target 80%

41. Compared Nationally TC-A 2013 2016 Sg2 Key Metrics DRG 870 DRG 871
Lagging Performers
Standard Performers
Top Performers
TC-A
Mortality Rates
DRG 870
> 44.4%
33.3%
< 22.2%
42% %
DRG 871
> 24.8%
21.1%
< 14.5%
24% %
DRG 872
> 5.7%
3.8%
< 2.0%
3.6% %
Sg2 is a third party analytic company that we pay to provide us data so that we can better allocate our resources. One of the services they provide us is comparative statistics. This table shows that in two of the three sepsis DRGs Appleton Medical Center is just better than a “lagging performer” in regards to sepsis mortality. This is important because sepsis is the number one cause of mortality nationally in non-cardiac ICUs and more relevantly in both AMC and TCs ICUs. These patients are usually the sickest patients in the hospital. They have the longest length of stays and the highest cost per case, which may be justified if we were improving their conditions. But we are not, these patients far too often do not survive as you can see by their mortality rates.

44. ThedaCare Medical Center – Shawano
2016
Emergency Dept. / Inpatient Sepsis Improvements and Updates

45. Before August 2016, Sepsis was identified as an issue across the ThedaCare System.
August Shawano had a 20% bundle compliance for Sepsis, this was the lowest of all Thedacare Hospitals

46. Changes
August 2016, Jason Bruecker RN and Nicholas Schutt RN became Sepsis Champions for the Shawano Campus
Jason and Nick started looking at the issues and identified the barriers within the ER. this included not knowing how to fill out the Sepsis BPA and not validating vitals in “real time”

47. Recent Changes/Key Learnings
Visual Sepsis Board
Real Time Updates
Pharmacy
Lab
Sepsis Champions have recently provided visual updates for all staff. We have initiated a “Sepsis Board” in our unit so providers and staff can see our trends and our monthly data.
We currently track: Antibiotic Administration Times, Lactic Acid/Blood Culture Collection Time, and Fluid Administration Timing. (November we added “variance feedback” for providers and staff so they know why some items were not met in the targeted timeframe) example: difficult lab draw, dialysis patient or not ordered by provider
Jason and Nick provide a daily “Real Time” view and update of sepsis chart audits, these are displayed on the Sepsis Board located in the ER breakroom
ER has worked closely with Pharmacy to get antibiotics in the Pyxis that were not readily available. (In the past we would have to get certain antibiotics from the Hospital Supervisor and this would delay administration times)
ER has been meeting with the Laboratory to discuss the importance of the Sepsis protocol. Workflows and processes were also updated by both departments to help improve our lab collection times and Sepsis work.

48. Outcome and Growth
October we really started to see our hard work pay off.
October 96%
November 86%
December 100%

49. Recent Changes/Key Learnings
Nursing Staff
Physicians
Inpatient
Local Emergency Department Clinical Council
Nursing staff was unaware of the effects of sepsis and how it ties into our work and the patient outcomes, Jason and Nick provide feedback to nursing staff and they are very open to constructive criticism and education opportunities
Negative Physician feedback, providers did not like their names displayed on the Sepsis Board with “red” next to their names. This created conversation amongst nurses and the providers and it also stressed the importance of early treatment and positive patient outcomes.
Inpatient Sepsis work has been identified as an issue. Nursing staff is not aware of the BPA or how to fill it how, how to identify early sepsis. Physicians we found that there was a disconnect from the ER providers to the hospitalists on the order sets. This is currently a work in progress. There is an upcoming inpatient education day that Jason and I are teaching nursing staff about sepsis.
Local ED council is enhancing and helping to engage employees in the positive work that we are doing as a group. Sepsis work has also helped the ED work with other disciplines in the hospital such as Lab and Pharmacy.
Some of the work our local council has found as issues include: ED to Floor Admission Times, Employee Recognition and Medication Reconciliation.

50. Questions?

51. Thank You Mentors!

52. Break
15 minutes

53. Workgroup Activity
Work with other hospitals and your hospital team to brainstorm and develop action plans on how to move forward with Sepsis initiatives.

54. Report Out – Action Plans
Hospital teams describe what they worked on, communicate action plans and if you have the support and necessary tools to move forward.

55. Mentor and Host Thank You

56. Resources WHA Quality Center MHA Community Page
ASP Starter Pack
Implementation Guide
Archived Webinars
Discussion Board

57. Next Steps… Scanning of your Action Plans 30 day follow up:
Phone call with Improvement Advisor on your action plans and small tests of change
60 day follow up:
Virtual event/call with all hospitals to highlighting hospitals successes. Details to come.
Date: August 17th 1-2pm
Resources from IAN on WHA Quality Center Website

58. Evaluation +/-

59. Contacts Beth Dibbert Improvement Advisor/Quality Director
Shruthi Murali
Improvement Advisor
Jill Hanson
Bobby Redwood
Physician Improvement
Advisor
Nadine Allen
Kelly Court
Chief Quality Officer