CS98 - No Nurse Left Behind: Sharing The Lessons Learned after 4 Years of the Surviving Sepsis Campaign
Primary Author: Kirsten Springer
Co-Author(s):
Institution: Mission Hospital, Mission Viejo, CA
Contact Email: kirsten.springer@stjoe.org
   
Purpose: In response to the unacceptably high morbidity and mortality of severe sepsis and septic shock patients, the adoption of the Surviving Sepsis Campaign (SSC) guidelines was instituted in a non-for-profit, community, trauma hospital. Our goal was to reduce morbidity and mortality, to drive compliance with the bundle elements, and to create a culture change. For our goals to be accomplished, we had to engage every nurse on every unit; no nurse left behind.
Description: Knowing the SSC may be more difficult to implement than other evidence based therapies, the initiative was driven by a dedicated sepsis coordinator. We had a trauma coordinator and a stroke coordinator, why not a sepsis coordinator? Utilizing Meditech, we were easily able to capture robust data from the SICU, CICU and med/surg wards. We utilized statistical analysis to determine efficacy. We analyzed the systems in place, the care provided and patient outcomes. Essential for success, we paid attention to the lessons learned nationally over the past 4 years surrounding sepsis implementation. A “tool-kit” approach with broad, house-wide implementation was completed. 10 multidisciplinary groups collaborated to produce a "root-cause analysis" on each barrier to implementation. Emergency, critical care and medical/surgical units worked with one focus in mind: patient flow, communication across units and problem solving areas of opportunity. Since implementation, we have full data on 76 patients with severe sepsis or septic shock who were admitted with an intent-to-treat and had at least one critical care bed day.
Evaluation/Outcomes: When compared against 2007 (n=57) data, in-hospital mortality from 29.8% to 15.8% (p<0.05). The percent of respiratory failure requiring intubation was reduced from 58% to 35% (p<0.05). The percent of sepsis patients who developed acute renal failure requiring hemodialysis was reduced from 18% to 11% (p=0.32). Compliance with early goal directed therapy improved from 0% to 71% and the rate of lactate screening increased from 63% to 96% (both p<0.05). A dedicated sepsis coordinator with a clear undersunderstanding of common barriers in sepsis care can more easily develop creative, house-wide system solutions and may increase the probability of successful implementation.
   
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