Common Barriers to Implementing the Sepsis Care Model October 2015

CONFIDENTIAL - Internal Use Only HVHC Sepsis Care Model Beginning 2013, HVHC members have been meeting regularly to review data and best practices for patients with sepsis. The HVHC sepsis project adopted the Surviving Sepsis Campaign (SSC) 3-hour bundle after review of the available evidence. The HVHC sepsis bundle has been implemented in 13 health care systems, delivered to over 6,000 patients between spring of 2013 and 2015. CONFIDENTIAL - Internal Use Only

CONFIDENTIAL - Internal Use Only HVHC Sepsis Care Model Implementing the HVHC Sepsis Care Model may require change in in care processes, roles, protocols, and EHR support. Common barriers to implementing the 3-hour bundle have been identified by: Discussions with members of the HVHC Sepsis Improvement Project Team Review of reports submitted by HVHC members Interviews with senior leaders, managers, and frontline care teams at several sites CONFIDENTIAL - Internal Use Only

Common Barriers to Implementing the HVHC Sepsis Model Difficult to accurately record the volume and timing of IV fluids Length of time required to make changes in the EHR Access to meaningful data Changing roles and responsibilities Communication Maintaining momentum and focus CONFIDENTIAL - Internal Use Only

HVHC Members with Solutions Difficult to accurately record the volume and timing of IV fluids DHMC: planned wireless smart pumps with barcodes that automatically populate the EHR Length of time required to make changes in the EHR U Iowa: best practice alerts in Epic record DHMC: SuperSIRS alert in general care areas (validated) with pager alert to sepsis RN Access to meaningful data NSLIJ: data analytic team produces reports with interpretation of what the data means for care teams CONFIDENTIAL - Internal Use Only

HVHC Members with Solutions Changing roles and responsibilities VMMC: “power hour” nurse protocol DHMC: Clinical Nurse Specialist who monitors hospital performance on sepsis, educates and trains staff DHMC: RN initiated sepsis intervention protocol Communication BIDMC: personal emails from physician champion NSLIJ: clear goals for improving sepsis are communicated through out the system by senior leaders Maintaining momentum and focus NSLIJ: re-commitment to sepsis improvement every year CONFIDENTIAL - Internal Use Only