Early Recognition and Management of Sepsis for HHS

1. Early Recognition and Management of Sepsis for HHS Meeting 2 Pat Posa RN, BSN, MSA, CCRN-K, FAAN Quality Excellence Leader SJMHS

2. Early Recognition and Management of Sepsis • Welcome • Program design • Evidence-based and best practice education and training on protocols and tools necessary for early recognition of sepsis • Interactive and integrated team approach with all health professionals • Case-based approach • Utilizes Performance Improvement Plan • Includes home health agencies and discharging facility • Required data collection over the period of the improvement project and beyond and includes how to track and trend the data

3. Early Recognition and Management of Sepsis • Results: participating agencies implementing a sepsis protocol such that: • Improved screening and identification of septic patients receiving home health services • Improved identification of patients with sepsis • Improved early interventions for patients with sepsis • Reduced admission or readmission (30 and 90 days) • Reduce the severity of sepsis when admission is required • Assessment of current infection prevention practices for pneumonia, UTI’s and wounds • Implement one infection prevention practice to close the gap between current state and best evidenced based practice for each infection • Reduce mortality rates for those with sepsis (save lives) • Agency Expectations: • Implement sepsis screening tool and treatment protocols as provided in Early Recognition and Management of Sepsis Program • Participate in monthly learning sessions • Participate in a coaching call between session 1 and 2 • Submission of process data

4. Program overview • Pre-work prior to first session (watch a video) • 3 in-person 90 minute session (consecutive months) • 1 virtual 60 minute session • One coaching call between session 1 and 2

5. What We Did Last Meeting • Overview of the program with facility roles and responsibilities • Education on sepsis, incidence, pathophysiology, early recognition (screening) and management • Reviewed staff education plan and resources • Reviewed Action Plan for sepsis early recognition and management • Defined homework

6. Agenda for Today’s Meeting • Implementation Strategies • Patient Education • Other Educational Tools • Screening Audit

7. Round Robin: Share Homework • Review results of steps 1-4 on action plan • Governing Board support • Define screening process • Upon admission and every visit by all clinicians • Screen 5 patients using the screening tool • How did it go? • Was it difficult to use? Did it flow? Any questions? • Share education plan and go live date

8. Sepsis Early Recognition Action Plan

9. Patient and Family Education • Materials from Sepsis Alliance and CDC Sepsis.org

10. Patient Family Education

11. Patient Family Education

12. Audit Screening Process • SEPSIS Screening Compliance • Evaluate if screening is being completed with each visit • Four weekly audits a month- • sample of 30 unique patient visits • SEPSIS Screening Accuracy • Evaluate if the screen is performed correctly • 5 patients of the 30 random sample once a week • Four weekly audits a month

13. Excel Sepsis ScreeningData Collection Tool

14. Sepsis Screening Audit • Excel file created to assist in data collection • First tab is data collection tips

15. Practice Audit: Compliance • Denominator is always 30 • Of the 30 patients • 25 had completed screenings at the visit • 5 did not have any screenings on the visit • How many patients are compliant? 25 Numerator

16. Let’s Enter The Data

17. Practice Audit: Accuracy • You need to audit 5 of the 30 patients for accuracy • Of the 5 selected patients, 3 had an accurately completed screening at the visit • How many patients were screened accurately? 3 Numerator

18. Let’s Enter the Data

19. Process Improvement • Use auditing to determine areas of improvement • Pay attention clinicians that may not be completing screening • Develop plans to address issues • One on one education • Rotate clinicians that are being audited for accuracy • May want to develop SEPSIS champions, who can coach/mentor others that are struggling

20. Practice Audit Mr. Smith is an 86 year old male referred to home care services after geropsychiatry hospitalization for mood disorder. He is returning to a new group home environment and has seven medication changes since his hospital admission. After discharge, the home care nurse initiates care the next day in the patient group home. The caregiver describes the patient’s behaviors as disruptive and he did not sleep last night. Upon assessment the patient displays no behaviors and is actual very calm and weak. He presents as follows: SEE Separate Handouts - did they screen accurately?

21. Readmission Review • Should review each patient that is transferred to the hospital for infection or sepsis • Evaluate if patient screened appropriately • If screened positive, were the appropriate treatments initiated? • Why was this transfer necessary? • Could this transfer have been prevented? If so, how?

22. Sepsis Early Recognition Action Plan

23. Homework • Complete steps 4*-6 on action plan • Develop and implement education plan for all staff • Define go live date for screening • Develop and implement patient/family education plan for sepsis • Define audit process and collect first one • Come prepared to share what you have done during the Round Robin at the next meeting *4-if not done

24. Questions?

25. Thank you for your participation in this important work