Sepsis Management National Clinical Guideline No. 6

1. Sepsis Management National Clinical Guideline No. 6 Implementation at Wexford General Hospital – October 2015 Shelagh Twomey, Quality & Safety Manager

2. Wexford General Hospital - Profile • Part of Ireland East Hospital Group (IEHG); • Provides acute service to County Wexford and some services to Waterford, Kilkenny, Carlow and Wicklow; • Number of beds: 242 (209 in-patient/33 day); • New ED in 2014; • New Delivery Suite and Obstetric OT – 2015; • Clinical Staff – 500 approximately.

3. Sunny South East

4. Commitment – getting started • Presentations x 2 – January 14th 2015 by Dr Vida Hamilton (attendees: 95+37=132) • Meeting with Senior Management, (GM, CD, DON&M) to secure commitment; • Governance: • Clinical Director/corporate lead; • Eilis and Shelagh – change agents • establish sepsis implementation group; • monitor progress via Quality and Safety Executive. • Clinical champions – nominated by CD.

5. January 14th 2015, WGH

6. What happened next? • Clinical Director nominated clinical champions and letters outlining role sent – (education, lead) • Await final versions of national forms; • Sepsis Guideline flagged at meetings; • Dr Vida Hamilton met potential Sepsis Implementation Group members on Tues, June 30th – update and increase readiness; • Sepsis Implementation group – first meeting September 1st.

7. WGH Sepsis Implementation Group Clinical Director; Consultant Geriatrician; Emergency Consultant; Obs and Gynae Consultant; Practice Development; Quality & Safety Manager. Clinical Nurse Manager Grade III – • Emergency & AMAU; • Peri-operative; • Medical; Director of N & M; ADON x 2;

8. Resources and Education strategy • Standardised ‘Sepsis Implementation’ presentation; • Made link with Early Warning Score documentation; • Sepsis Folder for all ward areas (bar MAT and Paeds) • Sepsis algorithms – laminated A3 for clinical areas; • Sepsis Pathways/Forms provided as handout at each session – ‘know what is on the form’; • Local Anti-microbial guidelines; Sepsis Cards; • Shared Folder for all WGH users – ‘Sepsis’ • Most effective resource by far – the Rory Staunton Video Clip

9. Rory Staunton Video Clip – ‘A Hidden Crisis’ http://rorystauntonfoundationforsepsis.org/about-rory-staunton/videos/

10. WGH Sepsis Folder National Guideline; List of Resources; List of iSTAT machines; Sepsis Group Membership; WGH Powerpoint; Sepsis Pathway (laminated). Antimicrobial Guidelines for Acute Hospitals in South East, July 2015

11. Communication and Education Communication Blitz clinical staff – emails, posters, reminders, flyers, leaflets • 10 sessions Sept and early Oct • Doctors/nurses/HSCPs – together! • 53%of clinical staff attended; • Ward based sessions – CNM3s/ADONs; • Each session: Rory Staunton Clip & Sepsis Powerpoint – Sepsis Pathway as handout.

12. Implementation proper • When? FromMonday 5th October, 2015… • What? Sepsis Pathway for adult in-patient – all adult in-patient areas (bar Maternity and Paediatrics); Sepsis Pathway - patient presenting to ED. • Feedback so far – forms being completed; ED nurses say pathway improves care; not being filed chronologically in HCR; one ICU nurse’s experience

15. Some of our learning… • Use national forms – get your Professional Print done early; • Arrange for the forms to be punched! • Involve night staff/ADON etc; • Secure Medical Grand Rounds slot; • Get clinical staff together for education! • Ensure NCHDs get communications; • ISBAR – ensure message of good quality.

16. Learning - ISBAR

17. Next Steps….. • Monitoring and audit

18. Closing Thought….. ‘A smooth sea never made a skilful sailor…..’