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Sepsis-QIpresentation.pptxSepsis
Lexi Gibrick, Anna Wojtowicz, Brayan Aguirre
Background of problem:
Sepsis is a medical emergency that describes the body’s systemic immunological response to an infectious process that can lead to end-stage organ dysfunction and death
Sepsis is the 3rd leading cause of death in the United States
More than 30 million people are affected by sepsis every year worldwide
Early detection of sepsis with timely, appropriate interventions increases the likelihood of survival for patients with sepsis
PICO: For adult patients in the Emergency Department, do sepsis alerts and screening tools, as compared to no early detection tools, reduce the mortality rates of patients?
Background of problem
Who is at high risk?
Adults 65 and older
Chronic health conditions
Weakened immune system
Sepsis survivors
Recent hospitalization
Signs and symptoms
High heart rate
Fever and/or shivering
Shortness of breath
Confusion
Pain
Feeling of impending doom
Analysis of Problem: Sepsis Data
| Month | Our Unit | Comparison Unit - 1 | Comparison Unit - 2 |
| January | 1 | 1 | 0 |
| February | 1 | 1 | 0 |
| March | 4 | 3 | 1 |
| April | 7 | 0 | 0 |
| May | 5 | 0 | 2 |
| June | 12 | 1 | 0 |
| July | 13 | 0 | 0 |
| August | 16 | 0 | 1 |
| September | 18 | 0 | 0 |
| October | 8 | 0 | 0 |
| November | 9 | 3 | 7 |
| December | 10 | 1 | 0 |
Our Unit:
Mean - 8.67
Median - 8.5
Range - 17
Comparison Unit - 1:
Mean - 0.83
Median - 0.5
Range - 3
Comparison Unit - 2:
Mean - 0.92
Median - 0
Range - 7
Number of Cases
Analysis of problem
Current practice at our facility:
If the patient’s temp is 101 or less, they are placed in regular ER rooms and tested for Covid-19
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Patient arrives into our ED (via walk in/ ambulance)
Basic assessment and triage is completed
They are seen by the physician in the order in which they arrived and based on their acuity. The doctor will then order labs to be drawn.
(CMP, CBC, sputum, UA) *1-2 hours for results*
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Evidence based practice:
If WBC’s are over 12, patient receives wide spectrum antibiotic until we know what antibiotic will work.
* this usually takes 24-48 hours to determine. By then patients are already in their hospital room. *
If patient meets Sepsis criteria, sepsis alert is activated by EHR.
Sepsis trained nurse finishes assessment and determines if sepsis alert is required. *Notfies MD*
*
Patient arrives to ED (via walk in/ ambulance)
Assessment and triage completed with assistance of sepsis screening tool.
EHR prompts RN/MD to input sepsis order set.
Sepsis order set: CBC, CMP, Lactate, CRP, PT/PTT, Blood cultures X2, UA, Urine culture, EKG, 1L bolus, Antibiotic
Lab results are prioritized for sepsis patients and transferred over to EHR. Pharmacy acknowledges antibiotic use and fluids based on weight.
*This leads to faster intervention and doctor able to focus more on finding source of infection.*
Sepsis mortality increase
Improved/overcame sepsis
Analysis of problem
Action Plan
Establish an alert system for high risk/potential septic patients into the EHR
EHR able to detect abnormal V/S indicating risk or potential septic patients.
EHR able to detect abnormal lab values significant for sepsis
EHR creates hard stops for user when sepsis criteria is met forcing user to use critical thinking on identifying sepsis.
EHR recognizes sepsis and allows user to input sepsis order set: (CBC, CMP, Lactate, CRP, PT/PTT, Blood cultures X2, UA, Urine culture, EKG, 1L bolus, Antibiotic)
Action Plan
Educate all Emergency room nurses on identifying and treating septic patients
WHEN DO WE EDUCATE?
Education at new hire orientation
Repeat yearly education for all staff
Refresher courses at ED skills day (bi-yearly w/ sim)
Refresher course with triage training
HOW DO WE EDUCATE?
Assess for readiness and identify barriers
Conduct educational sessions
Develop and organize quality monitoring systems
Distribute educational materials (signs/symptoms)
Provide centrally located references for all staff
Repetition on identification
WHEN DO WE TREAT?
Immediately
Action Plan
Improve the communication system for faster collaboration on sepsis alerts
Faster communication between nurse to MD notification
Faster lab results for sepsis alerts
Faster communication to pharmacy for faster IV antibiotic administration
Action Plan
| Who | What | Where | Why | When | How |
| Nurses | Activate Sepsis Alert System | Emergency Department | To reduce mortality rate in septic patients | Immediately, as soon as warranted. | Work with ED team on early recognition, and rapid/ aggressive treatment |
Goal: 100% of all septic patients will have the sepsis alert system activated in the Emergency Department.
Benchmark: Data will be collected every 6 months to assess if all septic patients have had the sepsis timer activated in the Emergency department.
References
Gyawall, B. (2019). Sepsis: the evolution in definition, pathophysiology, and management. Pubmed. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6429642/#:~:text=Sepsis%20is%20a%20medical%20emergency,stage%20organ%20dysfunction%20and%20death.
Hou, C., & Kraemear, M. (2016). Statewide sepsis initiative. Ohio Hospital Association. https://ohiohospitals.org/OHA/media/OHA-Media/Documents/Patient%20Safety%20and%20Quality/Sepsis/Webinars/16-Sepsis-Initiatives-Kennedy-Health-System-in-Stratford-NJ.pdf
Jeffery, A. D., Mutsch, K. S., & Knapp, L. (2014). Knowledge and Recognition of SIRS And Sepsis among Pediatric Nurses. Pediatric Nursing, 40(6), 271–278.
Symptoms. Sepsis Alliance. (2021). Retrieved September 11, 2022, from https://www.sepsis.org/sepsis-basics/symptoms/
Tuberc, R. (2019). Sepsis: early recognition and optimized treatment. National Library of Medicine. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6304323/
