NHS Borders Sepsis Webex 25 th April 2013

1. NHS Borders Sepsis Webex 25th April 2013

2. NHSBorders Melrose

3. Core Team Members Evelyn Fleck Director of Nursing and Midwifery, Executive Lead Dr Edward James Consultant Microbiologist, Consultant Lead Ronnie Dornan Clinical Nurse Specialist, Critical Care Outreach Dr Jonathan Aldridge Consultant Anaesthetics & Intensive Care Geoff Anderson Charge Nurse, Ward 7 Lisa White Sister, Ward 7 Dr Anne Duguid Antimicrobial Pharmacist Adam Wood Senior Nurse Specialist, Infection Control Julieann Brennan Clinical Audit Facilitator Christine Irving Clinical Practice Facilitator for IV Meds Ellen Poole Staff Nurse, Ward 12 Allison Roebuck Patient Safety Administrator Julia Scott Clinical Governance & Quality Facilitator: Patient Safety Gill Lunn Senior Midwife/ Maternity Champion Lorraine Dickson Hospital at Night Team FY1 docs From Wards 4, 7, 12 and A&E

4. BGH SEPSIS Driver Diagram Specific Change Ideas Secondary Drivers Increase confidence in the monitoring tool – identify early symptoms through the Implementation of the screening tool to include the SEPSIS 6 checklist Development and modification of current tool (SIRS) to include (SEPSIS 6) – Sepsis bundle Primary Drivers Timely rescue of patients identified through reliable escalation to higher level of care Ensure appropriate medical intervention and timely rescue of deteriorating patient by competent teams Increase the number of patients who receive antibiotics within 1 hour of recognition - Achieve 80% initially. Reliable Recognition & Assessment AIM Support education on burden of illness and current performance Reliable Care Delivery To improve recognition and timely management of patients identified with sepsis on ward 7, by achieving 95% compliance with evidence based therapy (SEPSIS 6) by September 2013 Provide training to staff on clinical knowledge and improvement skills Ensure reliable process of communication through SBAR for consultants, doctors, nursing staff and outreach teams. Refine Education & Awareness Establish Ward agreement for implementation Promote a Culture of safety & Improvement Establish working relationship with Clinical Governance and Audit for project support in developing a measurement framework to guide improvement Increase understanding of condition all professional, patients and public – “SEPSIS as a medical emergency” e.g. Local and National awareness campaign Improve Patient and Family Centred Care Develop Communication – posters/information Involve Patients and family in treatment processes and planning and ensure appropriate feedback and understanding is provided. Link “at risk” patients with ward safety brief Develop an effective and appropriate support through executive sponsorship, clinical lead, multidisciplinary team working, approval/money support Development of team project support

5. Tests of change Version 10 Version6 Initial Test

6. Data Collection Form

7. O2 Results: Blood Cultures

8. Fluids Results: IV antibiotics

9. Lactate Results: Urine output

10. Compliance with Sepsis 6 Percentage of patients with Sepsis Six performed within 1 hour of time zero

11. 2012: 2 + hrs 2013: < 30 mins Diagnosis Delay

12. Balancing measure: Are all Patients with a SIRS of 2 and above captured? Spot checks on all the wards are done monthly on one day . The spot check includes checking all patients SIRS chart on all the wards for a reading of ≥ 2 using the headings. 44 notes were inspected on 18th April 2012. 3 patients had a SIRS of 2. 2 received Sepsis Six. 1 did not enter into the programme.

13. Our Successes Patients are increasingly receiving evidence based treatment for sepsis Patients are receiving timely management We have a committed driven team We have increased awareness of the sepsis six interventions We have achieved a better understanding of the interconnection between the process and outcomes of the interventions We have achieved meaningful real time data collection Have successfully used the model for improvement and PDSA methodology Well received at ‘Grand Round’

15. Our Challenges AUDIT Time resources and capacity The early recognition of sepsis New FY1 every 4 months (+ Rotating Shifts (wards/HAN/Day/ night)) Nursing teams relying on “bank staff” frequently Hospital wide education The compliance with the use of the sticker for all patients with a SIRS of 2 Highlighting sepsis as a medical emergency Concern with diagnostic accuracy obscures the early recognition of Sepsis Maintaining momentum Keep the focus of the model for improvement Achieving standardisation and sustainability as the project develops

16. Forward Planning: Create a structured monthly feedback on all wards. Create a Sepsis Pathway. Increase awareness in the middle grade doctors. Incorporate the Maternity Units/ McQIC workstream. Review progress and continue to have local core group meetings every 2 weeks. Improve the data collection sheet (PDSA). Learn from mortality reviews.