Utilizing Sepsis Champions to Decrease Sepsis Mortality

Abstract

Session D presented Thursday, September 27, 2:30-3:30 pm Purpose: The ED utilized sepsis champions to provide education and resources to their peers. The objective was to decrease sepsis morbidity and mortality by increasing early goal directed treatment. Design: This evidence-based project was a plan, do, study , act cycle utilizing sepsis champions from the ED to provide insight to barriers in early recognition and treatment of patient. Setting: The setting is a 130 community hospital. The ED is a 21 bed, mixed adult and pediatric, facility seeing 105 patients a day. Participants/Subjects: An interdisciplinary team of: Five ED Champions, one in-patient RN, the whole ED staff, quality, laboratory, pharmacy, Family Practice, Hospitalist, education, and nurse managers. Patients that met the criteria for severe sepsis would have initiation of Code Purple. Methods: The sepsis worksheet included: infection or possible infection, systemic inflammatory response symptoms, and organ dysfunction parameters. The reverse side of the worksheet included: (a) time zero, (b) presenting criteria, (c) calculation of fluids based on weight and start time of the fluids, (d) time lactic acid and blood cultures drawn and result of lactic acid and white blood cell count (e) broad spectrum antibiotic selection and start time, (f) reassessment of vital signs following treatment and (g) result of second lactic acid if initial result was > 2. The Sepsis Champions launched poster education highlighting increased mortality when EGDT is not initiated, sepsis worksheet and the code purple process. The RN would order the triage sepsis order set: (a) CBC, (b) CMP, (c) paired blood cultures, (d) lactic acid, (e) IV lock, (f) 500 ml IV bolus, (g) weight, (h) NPO, and (i) urinalysis. The provider would order the three-hour sepsis bundle order set which included EGDT. Quality worked to remove redundancy between these order sets. A Code Purple dot phrase was added to the EMR for report which pulled in metrics without relying on memory. The transportation of lactic and blood culture specimens were also streamlined. Sepsis compliance metrics were shared monthly at ED unit meetings and during huddles. Results/Outcomes: Prior to Code Purple, Sepsis Core Measure Compliance was 48%. In August 2017 the compliance which includes: lactic, blood cultures, IV fluids 30ml/kg, board spectrum antibiotics, repeat lactic acid and reassessment was 92%.The sepsis mortality index dropped from August 2016 at 1.31 to 0.51 for September, 2017. The metric for repeat lactic acids was around 50% in October 2016 and January 2017 showed an improvement of 95%. The use of sepsis order sets which sees inverse results as its use increases mortality rates decrease was at about 75% in October 2016 and in January 2017 was over 90%. Implications: On October 9th 2017 the process was extended to the In-patient units. The same foundation of utilizing Sepsis champions from each unit to educate and mentor their teams to the Code Purple process was implemented. The team that responds is comprised of the: nursing supervisor, intensive care unit (ICU) nurse, ED nurse, and phlebotomy. One of the next steps for this project includes improving antibiotic administration time to within one hour of time zero.