Activate the Lactate

Providence Sacred Heart Medical Center & Children’s Hospital (Spokane, Washington)

CSI Summary

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CSI Presentation

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CSI Toolkit

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Project Topic

Improving sepsis recognition and alert activation by implementing point-of-care lactic acid testing (POCT)

Hospital Unit

Emergency Department

CSI Participants

Malia Arthur, BSN, RN
Megan Brighton, BSN, RN
Robyn Maehren, BSN, RN, CEN
Angela Shemwell, BSN, RN, CCRN

Project Goals/Objectives

  1. To increase sepsis recognition and alert activation in triage 20%
  2. To achieve completion of vital signs (Temp, HR, BP, RR) and POCT lactic acid in triage within 30 minutes of arrival 50% of the time
  3. To increase sepsis bundle compliance 20% by improving recognition of sepsis in patients meeting systemic inflammatory response syndrome (SIRS) criteria

Project Outcomes

  1. Increased sepsis activations in triage 24.4%
  2. Achieved completion of vital signs and POCT lactic acid in a median time of 24.5 minutes
  3. Reduced median time from triage to sepsis activation 50%
  4. These outcomes resulted in a projected annual fiscal impact of $195,480.

Project Overview

Sepsis is the number one cause of mortality in hospitals nationwide. Sacred Heart’s own Emergency Department initiated 1,468 adult sepsis activations in 2019. Knowing, the risk of death increases on average 7.6% with each hour sepsis treatment is delayed, our CSI team identified using lactic acid point-of-care testing (POCT) as a tool to improve outcomes and time to treatment for our sepsis population.

We met with the laboratory department, which completed validation studies to ensure our lactic acid results would be accurate, and obtained the cartridges and a POCT machine to conduct bedside testing. Next, we created a triage protocol for CSI team members to test patients and record results in the electronic medical record. With the help of the Quality Department, we created a database to compare patients admitted with sepsis in 2018 to our “Activate the Lactate” trial in 2019.

We focused our staff education efforts on sepsis, SIRS and qSOFA criteria. We hosted a week-long kickoff party to introduce staff to the “6 Tasks in 60 Minutes” approach for completing initial sepsis care that was originally used by our partner hospital. During that week, our CSI team provided education during unit huddles twice a day, bringing in food and giving away swag to generate staff excitement. We also created posters throughout the year and displayed them in our unit. Additionally, we developed a research poster and presented our project at a local critical care conference and a system-wide virtual research conference.

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The materials associated with this AACN Clinical Scene Investigator (CSI) Academy project are the property of the participating hospital noted above, not AACN. Requests to use content contained in the CSI team’s summary, presentation or toolkit should be directed to the hospital. We suggest reaching out to the hospital’s Communications, Marketing or Nursing Education department for assistance.

The AACN CSI Academy program supports change projects based on quality improvement methods. Although CSI teams seek to ensure linkage between their project and clinical/fiscal outcomes, data cannot be solely attributed to the project and are estimations of impact.