Acute Care Perspective How Power Hour is Saving Lives at Virginia Mason Christin Gordanier, RN MN Inpatient Nursing Director April 1, 2016

The Virginia Mason Sepsis Bundle SIRS any 2 TEMP > 38.0, < 36.0 HR > 90 RR > 20 WBC > 12, < 4 > 10% bands Sepsis SIRS + Possible Infection Severe Sepsis + Injury: Lactic Acid Creatinine Delirium Septic Shock Hypotension 2L NS Bolus Check Lactate Draw Blood Cxs Start Abtcs Recognize Sepsis Initiate Bundle < 1 hour

Standardization and Reliability Standard criteria to identify the condition Order sets Checklists Bundles and kits Visual Controls Intake huddles Standard work

Why focus on low grade sepsis? Septic Shock Hypotension 1817 Deaths @ Kaiser Permanente Northern CA Liu Et. Al. JAMA July 2014

Do it Faster! “Can that be done?” < 1 hour

Early Recognition and Treatment in the Hospital Sepsis Power Hour = Early Recognition and Treatment in the Hospital Nurse Leads This is how we were able to create a system to achieve this goal.

RN Initiated Bolus for low BP Time to completion of 2L NS bolus improved from: 3hr 52min to 1hr 45min p < 0.0001 Time to MD arrival decreased from: 2 hrs to 50 minutes 189 patients Sebat, Chest 2005

Sepsis Power Hour: Nurse Leads RN Work: Identify Sepsis Check Lactate within 10 min Check Blood Cultures Start 500cc fluid bolus < 30mins MD Work: Confirm Sepsis Start Antibiotics Complete 2L fluid bolus < 60mins Pharmacy Work: Prioritize Antibiotics Dose and Prepare STAT Hand-Deliver to patient’s location

“Can that be done?” Dr. Calderon- Thank you for using the order set and ordering antibiotics STAT! The patient received antibiotics in 31 minutes, well under our 60 minute target. Thanks again, Alice

Power Hour Data (n=254)

85 Patients Power Hour Data (n=254) New antibiotic orders Don’t Wait, Initiate! Sepsis Power Hour New antibiotic orders 85 Patients

Power Hour…Does it work?

Reduction in RRTs

Sepsis Deaths

Improving Sepsis Care: Nurse Driven Protocols, Tools and Education Presented by Amy Corliss, MD, Medical Director of Patient Safety & Quality Dallen Johns, BSN, CCRN, CEN, RN Lorri Pilkington, BSN, CNOR RN Elissa Watson, BSN, RN Dr. Corliss: Sepsis care always been a focus. One year ago started Sepsis Committee. Recognize need for protocols, tools and education. What we are going to show today is collaboration of our efforts. We performed deep dive into our failures to identify opportunities.

WMH SEP-1 RN Tools for Success ED RN Screening Tools (in EPIC) ED → Admission: Sepsis 4 Life worksheet Inpatient RN Screening Tools (in EPIC) RN Education & Quick Reference Badge Quality RN Abstraction Tool for Concurrent Review Dr. Corliss

Emergency Nursing

ED RN Screening Tools (in EPIC) Sepsis Evaluation Question Added to RN Triage navigator: “Current s/s suggest systemic infection?” Best Practice Advisory if patient meets criteria for early sepsis Elissa

ED Sepsis Evaluation Question (ED Triage) Elissa

ED Nursing Best Practice Advisory Elissa

Elissa

ED → Admission Sepsis 4 Life Worksheet Dallen

Dallen

Dallen

Dallen

Blow up comment in previous slide Dr. Corliss

Dr. Corliss

Dr. Corliss

Dr. Corliss

Inpatient Nursing Elissa and Lorri

Inpatient RN Screening Tools (in EPIC) Elissa

WMH SEP-1 Nursing Education Lorri

Abstraction Tool for Concurrent Review Quality Nursing Abstraction Tool for Concurrent Review Lorri

Lorri

SEP-1 - Data Dr. Corliss

Questions?