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Team Photo Slide. How are we Surviving Sepsis?. TMH ICU Collaborative PDSA Model for Improvement. Plan Need for Change. Problem: Septic shock in surgical patients had high mortality Reason: Recognition came too late
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How are we Surviving Sepsis? TMH ICU Collaborative PDSA Model for Improvement
PlanNeed for Change • Problem: Septic shock in surgical patients had high mortality • Reason: Recognition came too late • Goal: Decrease mortality by improving early recognition of sepsis in surgical patients • Measure: Incidence of septic shock and mortality related to septic shock in surgical patients
Plan • Barriers • Education complexities: Large numbers/Multiple Disciplines • Modify: ED/Critical Care process for Med Surg areas • Empower: Nurses to obtain rapid treatment for their patients • Coverage: Limitations
Plan • Multidisciplinary Team • ICU collaborative members • Hospital Administration support • CPPD • Nurse managers • Physicians • Quality department • Nurse champions • Lab personnel • Informatics • Identified champions for every area
DO • Adapted education used for ED/Critical Care for pilot unit (surgical unit…. Dec./January) • Created a policy and algorithm adapted from ED • Provided unit based tools • Definitions • Algorithm with sepsis bundles • Sample SBAR to physicians for nurses • Badge cards
StudyThe Results Data collected by NSQIP and shared with ICU Collaborative
StudyLessons Learned • Education spread to all units, physician/LIP groups (Jan-April) • Shift to shift SBAR has sepsis screen included • Included sepsis in RRT activation criteria • Reinforced in education for RRT start up Tubes for lactate stocked on units • Order sets created • Links to SSC added to nursing & medical websites
ACTNext Steps • Continue to reinforce education • Routinely one on one • Presentation and case studies • Include in orientation • Online education • Module for Brown Students • Consider yearly competencies for nursing • Continue to analyze NSQIP data and integrate into departmental QI, M&M, ICU collaborative • Concurrent chart review • Need better follow up on some Pts ( +sepsis screen but not severe sepsis or shock or not really septic) • Abg lab will go online soon • Pt family education?
How are we Surviving Sepsis? Our surgical patients would have to say… “VERY WELL, THANK YOU!”