1. Saving Seniors from an Age-old Problem:
Improving Early Recognition of Severe Sepsis in Hospitalized Elderly
Sooi Yong Lo, BSN, RN, PCCN; Julie Gaspar, RN, PCCN; Cherie Neil, MSN, RN, NEA-BC, PCCN; Marisa Hallare, BSN, RN, PCCN; Linda Davila, BSN, RN, PCCN
Cardiac & Thoracic Surgery Unit – 7 West | Ronald Reagan UCLA Medical Center
IMPLEMENTATION
BACKGROUND
People and Partnership are 2 major components in the project intervention and sustainability measures striving to foster nursing accountability, autonomy, and ownership.
Sepsis is a healthcare emergency, particularly in elderly patient populations, who constitute 2/3 of sepsis cases and have mortality rates 1.3 to 1.5 times higher than those of adults younger than age 65.1
The adult Cardiac & Thoracic Surgical Unit began to focus on prompt recognition of severe sepsis in our medical-surgical patients age 65 or older (85% of our patient population) by pioneering dual-nurse sepsis screening during bedside handover.
Sepsis screening compliance, accuracy, and mortality showed initial improvement post implementation, leading to our next priority of achieving sustainability in these outcomes.
The project was tracked over a 3-year period to examine impacts on sepsis care, mortality rates, and nursing practice for hospitalized seniors.
Ongoing education to sustain awareness and practice adherence
1:1 in-services highlighting elderly sepsis care
Annual Skills Lab & Simulation
Unit posters
Bedside Handover observations of sepsis screen
Active dialogue with sepsis champions
Focused huddle messages
Direct coaching with case reviews
RN knowledge re-assessment surveys
Frontline Nursing Staff
Champion empowerment to enhance knowledge
sharing
7W unit champion forum
Enrichment with tools and resources
Champions leading pilot study
Sepsis Champions
People
Collaboration with
data analysts
System-wide committee participation
Resource provision for unit support
Strengthening of
Professional Governance
Early adopters, role models
Decision makers for sustainability efforts
Fostering of professional accountability, autonomy, ownership, and advocacy
Debriefing session
Provision of platform for voice + rallying of staff
Walking rounds to reinforce practice and provide support
Resource allocation
Proactive discussions with critical care RN team
Addressing early warning signs prior to deterioration
Mobilization of clinical resources to expedite sepsis care
Utilization of Modified Early Warning Scores (MEWS) for earlier identification of sepsis-related clinical deterioration
Clinical Surveillance Team
7 West
Unit Practice Council
Quality
Department
RESULTS
Screening compliance increased from 21% to a maintained average of > 90% over a 3-year span (a sustained 69% improvement).
Screening accuracy increased from 50% to an average of 67.5% over the same 3-year span (a 17.5% improvement).
RN knowledge re-assessment showed sustained improvement from baseline.
Mortality rates for the elderly population admitted to our unit decreased by an average of 28.9% over a 3-year-period.
Mortality rates for the elderly population discharged from our unit decreased by an average of 23.4% over a 3-year-period.
Nursing Unit Leadership
Partnership
PDCA Model
After the adoption of new screening practice
 Evaluate progress
 Refine process
 Identify practice variability
 Foster sustainability
Check & Analyze
 Unit-based data
- Random chart audits
Q 6 months
- Case studies
 Staff practice audits
 Bedside Handover observations
 Frontline nurse feedback
 Education reassessment survey
Act
Interventions:
 Multi-faceted education
 Champion cultivation
 Coaching for staff & champions
 Culture shift
 Leadership support
METHODOLOGY
CONCLUSION
OUTCOMES
Intentional efforts towards sustainability made true culture change possible. It involved building staff competency and providing challenges and intellectual stimulation to maintain staff engagement.
Consistent partnerships with a number of departments/ leadership was also a major factor in driving positive outcomes.2,3
NEXT STEPS
Definitions:
Screening Compliance defined as screening and documentation completed within 1 hour of start of shift, upon admission, and with change-of-condition.
Screening Accuracy defined by 3-point criteria established by the Quality Department based on current sepsis protocol.
Mortality rate defined by inclusion criteria of Age >65, sepsis-related diagnosis codes (ICD-10 or T8X), and admission to or discharge from 7 West.
Cultivate additional unit champions
Track utilization of UCLA Health’s new dynamic screening tool and its effect on screening compliance and accuracy
Evaluate impact of system-wide adoption of dual-nurse sepsis screening during bedside handover
Timeline Legend:
2015 Sepsis Milestone
2016 Sepsis Milestone
2017 Sepsis Milestone
2018 Sepsis Milestone
Sepsis Chart Audit
REFERENCES
1Nasa, P., Juneja, D., & Singh, O. (2012). Severe sepsis and septic shock in the elderly: an overview. World Journal of Critical Care Medicine, 1(1), doi: /wjccm.v1.i1.23.
2Kleinpell, R. (2017). Promoting early identification of sepsis in hospitalized patients with nurse-led protocols. Critical Care, 21(10), 1-4. doi: /s
3Mukherjee,V., & Evans,L. (2017). Implementation of the surviving sepsis campaign guidelines. Current Opinion in Critical Care, 23(5), doi: /MCC
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