Sepsis checklist decreases sepsis mortality
Donna Crimmins-Bonnell, MHSM, BSN, CPHQ; April Greenberg, RN, CEN; Ashlee McAdams, BSN, CEN
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Purpose: Lean Six Sigma Yellow Belt Project chartered to increase the use of our Sepsis Checklist as we were at 0% compliance and our Mortality OE was 1.35.
Aim: Primary: to increase initiation of Sepsis checklist, by 50% in ED for Sepsis positive patients by Dec 7, 2015; Secondary: to decrease Sepsis O/E (observed to expected) Mortality to an O/E below 1 by March 2016.
Design: Staff Development and Performance Improvment Project.
Setting: Acute Care 168 bed Hospital ED.
Participants/Subjects: ED staff, ED manager, charge nurse and ED Dir., Clinical Outcomes Team Lead and Director of Quality.
Methods: Lean 6 Sigma tools were used and PDSA. Discovery: Gemba, Fish Bone, Swim lanes…Plan/Do to educate, streamline process, decrease variation in locations Study: revised checklist for flow per nurses input; 2nd cycle revised for phy need; changed color of checklist for ease in handoff. ACT: variation in practice decreased…checklist part of ED culture.
Results/Outcomes: Primary and Secondary Goals were met and exceeded. As of today we continue to sustain the gains. Checklist use increased by 78%, O/E Mortality decreased to 0.73 YTD by Sept 2016.
Implications: >90% of Septic patients come in through the ED doors. Early recognition and treatment of sepsis is the key to patient survival. Use of the checklist allowed the staff to stay on task in a rapid manner which impacted the survival of our sepsis patients. Lessons Learned: Staff need to be educated in a consistent manner using an alogrithim to decrease variation in and potential for bias with trainers; staff signing the education tool enforces accountability; on boarding of new staff to process is essential; annual competency and monthly monitoring of the process decreases drift; Patient stories and lves saved help to sustain the momentum and change the culture.
ENA 2017: Education, Networking, Advocacy. Held at America's Center Convention Center, St. Louis, Missouri
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