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Team Up Against Sepsis

Providence Holy Family 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 outcomes through team-based rapid implementation of a sepsis bundle

Hospital Unit

Emergency Department

CSI Participants

Karin Kloppel, BSN, RN, CCRN, CEN
Barbara Richards, BSN, RN

Project Goals/Objectives

  1. Increase nurse compliance with sepsis bundles
  2. Increase early recognition of possible systemic inflammatory response syndrome (SIRS)/sepsis, and reduce sepsis incidence
  3. Decrease by 80% the time it takes to complete six sepsis bundle tasks: obtaining labs, lactate, two blood cultures, IV access, IV fluid resuscitation and administration of antibiotics
  4. Increase team response to sepsis alerts 80%

Project Outcomes

  1. Achieved completion of six sepsis bundle tasks in 60 minutes consistently
  2. Decreased time from sepsis alert to administration of antibiotics 64.2%
  3. Decreased time from antibiotic order to administration 64%
  4. Increased team response to sepsis alerts an average of 70%
  5. Decreased hospital’s overall sepsis-related observed/expected (O/E) mortality ratio mean from 1.15 to 0.8
  6. These outcomes resulted in a projected annual fiscal impact of $110,000, with an estimated CSI program return on investment over 600%.

Project Overview

Our hospital system had identified sepsis mortality reduction as a top priority. Our CSI team chose to focus on early recognition and treatment aspect of sepsis through improved sepsis bundle compliance in our 30-bed Emergency Department.

We wanted to implement a two-RN response approach, called “Team Up Against Sepsis,” for all sepsis alerts called in the ED. This approach was key to our efforts to encourage completion of six sepsis bundle tasks within 60 minutes to optimize patient outcomes. Our project team surveyed staff to measure awareness of SIRS/sepsis criteria and sepsis bundle metrics, and we educated staff, management and physicians about the project. We worked out solutions for challenges as they arose during the project.

Five months after implementation, data revealed a significant decrease in time from sepsis alert to antibiotic administration and from orders to antibiotic administration. The overall mortality rate due to sepsis was also reduced. The team response is now hardwired into our practice, and our sister hospital has begun replicating this model in their ED.

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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.