Project Sepsis By: Florence W. Zilko, RN, BSN, CCRN

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Sharon Roberts
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1 Project Sepsis By: Florence W. Zilko, RN, BSN, CCRN 1

2 Background According to the Institute for Health Improvement and the Surviving Sepsis Campaign, severe sepsis carried with it a mortality risk between 30-50%, and in the setting of shock, this rate is even higher. It is well accepted that building interventions for a disease such that algorithmic responses are carried out leads to better outcomes. 2

3 Background Sepsis can harm and kill patients if not treated quickly & increases ICU length of stay and its associated costs. Developing a Sepsis Response team protocol will help to identify patients in early sepsis and facilitate sepsis resuscitation bundle utilization. 3

4 Goal of Project Sepsis To assess the general knowledge of sepsis To promote early identification of a septic patient To enhance early treatment (by decreasing the diagnosis to treatment time) To educate the nurses 4

5 Objective Method/Project Component Outcome Measurement Assess the general knowledge of Sepsis Design a Questionnaire or survey Pre-test or a Pre Questionnaire Interview of nurses Survey sent by Diagnose: Promote Early Identification of a septic patient Formulate a new SBAR Sepsis screening tool Completion of screening tool Overarching goal: Enhance early treatment by decreasing the diagnosis to treatment time Doing an In service on how to use the Algorithm/Practice guidelines/ Order sets/ Screening tool SBAR Design an educational packet Post Test Identify current issues with electronic screening and educate nurses on new process Meetings with IT Update Sepsis CBT Create bedside reference and load to SharePoint In-services to MICU Staff Chart audits Changes made to electronic screening Completion of Sepsis CBT Reassess the nurses every 3 months 90% of staff in-serviced 5

6 Pre & Post Survey Questions 1. Which statement most accurately describes sepsis? 2. Which isn t a clinical sign of systemic inflammatory response syndrome? 3. Which phrase best defines severe sepsis? 4. Which blood test is used to assess tissue perfusion in a patient with sepsis? 5. Antibiotic therapy for suspected sepsis should begin 6

7 Pre & Post Survey Questions 6. In the presence of severe sepsis, septic shock is diagnosed when the patients lactate level is 7. The cytokines and white blood cells that are released during sepsis trigger 8. What maybe the first symptom of sepsis noted by clinicians? 9. When fluid administration fails to restore an adequate arterial pressure and organ perfusion, what therapy should be used: 10. What system do we currently have in place for sepsis detection and management? 7

8 SEPSIS RAPID RESPONSE STUDY PACKET Sepsis kills up to 50% of those infected. How many deaths will you prevent this year? 8

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12 Comparison of Pre & Post test results 12

13 Post test questions: PROBLEM! 1. Which statement most accurately describes sepsis? 2. Which isn t a clinical sign of systemic inflammatory response syndrome? 9. When fluid administration fails to restore an adequate arterial pressure and organ perfusion, what therapy should be used: 10. What system do we currently have in place for sepsis detection and management? 13

14 Findings from Post test: Nursing re-education is needed on: Definition of SIRS/Sepsis/Severe Sepsis/Septic Shock Treatment/Algorithm Clarification on current process of screening 14

15 Sepsis chart audits: Are changes being translated into practice? Is the system/timing/sequence reliable? Are the goals of the bundle being met? Time of blood cultures/antibiotic administration and lactate orders? Are they within 1hr in the ICU or 3 hr in the ED? 15

16 Findings: Timely completion of the nursing portion of the sepsis screening task is not being done There is delay from the time of trigger to the time that the screen is done. Inconsistencies in nursing documentation on documented/suspected infection. Changes made on Simple sepsis screen Masking the trigger and no supportive documentation 16

17 Findings Uncertainty on when Time zero begins. Clarification was needed on DNR/DNAR/DNI. NOT DONE option on the nursing task creates a 24 hr suppression Lack of communication/understanding on purpose of antibiotics 7 day suppression created if MD only ordered fluids for treatment 17

18 Plan of Action Nursing education to: Reinforce the importance of screening within the hour of the trigger. Define sepsis and the SIRS criteria Emphasize the need to know your patient. Create awareness on what systems are in place for sepsis detection and management. 18

19 Nursing Education Updated Sepsis CBT to reflect the new electronic screening process Designed a bedside laminated reference for nurses In-services given as verbal update on the process Created Clinical Update to be ed to all staff outlining the screening process Continuous random audits to be performed 19

20 Plan of Action Work with IT to improve the current screening process. The changes include: MD name and time of notification included as part of the screen The Sepsis screening tool assessment is now at the top of the work list 20

21 The suspected infection list will be visible before answering the question Does the patient have any documented or suspected source of infection. 21

22 IT changes NOT DONE option on the nursing task will be deactivated since ALL patients are to be screened in a timely fashion. Nursing narrative will be included to explain: Why + SIRS and SEPSIS? Or if VS were entered in error or due to pain/movement/agitation 22

23 IT Changes Items on 7 day suppression to be redesigned/reworded to include appropriate treatment and management algorithm 23

24 On going Active Sepsis Task Force nursing representative attending all meetings Continuously seeking/receiving feedback from bedside nurses on sepsis screening and relaying the information to relevant parties Audits on + sepsis screens Point of contact for sepsis related queries 24

25 Thank you :-) 25

SE5h, Sepsis Education.pdf. Surviving Sepsis

SE5h, Sepsis Education.pdf. Surviving Sepsis Surviving Sepsis 1 Scope and Impact of the Problem: Severe sepsis is a major healthcare problem that affects millions of people around the world each year with an extremely high mortality rate of 30 to