Saving Seniors from an Age-old Problem: Improving Early Recognition of Severe Sepsis in Hospitalized Elderly Sooi Yong Lo, BSN, RN, PCCN; Julie Gaspar, RN, PCCN; Cherie Neil, MSN, RN, NEA-BC, PCCN; Marisa Hallare, BSN, RN, PCCN; Linda Davila, BSN, RN, PCCN Cardiac & Thoracic Surgery Unit – 7 West | Ronald Reagan UCLA Medical Center IMPLEMENTATION BACKGROUND People and Partnership are 2 major components in the project intervention and sustainability measures striving to foster nursing accountability, autonomy, and ownership. Sepsis is a healthcare emergency, particularly in elderly patient populations, who constitute 2/3 of sepsis cases and have mortality rates 1.3 to 1.5 times higher than those of adults younger than age 65.1 The adult Cardiac & Thoracic Surgical Unit began to focus on prompt recognition of severe sepsis in our medical-surgical patients age 65 or older (85% of our patient population) by pioneering dual-nurse sepsis screening during bedside handover. Sepsis screening compliance, accuracy, and mortality showed initial improvement post implementation, leading to our next priority of achieving sustainability in these outcomes. The project was tracked over a 3-year period to examine impacts on sepsis care, mortality rates, and nursing practice for hospitalized seniors. Ongoing education to sustain awareness and practice adherence 1:1 in-services highlighting elderly sepsis care Annual Skills Lab & Simulation Unit posters Bedside Handover observations of sepsis screen Active dialogue with sepsis champions Focused huddle messages Direct coaching with case reviews RN knowledge re-assessment surveys Frontline Nursing Staff Champion empowerment to enhance knowledge sharing 7W unit champion forum Enrichment with tools and resources Champions leading pilot study Sepsis Champions People Collaboration with data analysts System-wide committee participation Resource provision for unit support Strengthening of Professional Governance Early adopters, role models Decision makers for sustainability efforts Fostering of professional accountability, autonomy, ownership, and advocacy Debriefing session Provision of platform for voice + rallying of staff Walking rounds to reinforce practice and provide support Resource allocation Proactive discussions with critical care RN team Addressing early warning signs prior to deterioration Mobilization of clinical resources to expedite sepsis care Utilization of Modified Early Warning Scores (MEWS) for earlier identification of sepsis-related clinical deterioration Clinical Surveillance Team 7 West Unit Practice Council Quality Department RESULTS Screening compliance increased from 21% to a maintained average of > 90% over a 3-year span (a sustained 69% improvement). Screening accuracy increased from 50% to an average of 67.5% over the same 3-year span (a 17.5% improvement). RN knowledge re-assessment showed sustained improvement from baseline. Mortality rates for the elderly population admitted to our unit decreased by an average of 28.9% over a 3-year-period. Mortality rates for the elderly population discharged from our unit decreased by an average of 23.4% over a 3-year-period. Nursing Unit Leadership Partnership PDCA Model After the adoption of new screening practice  Evaluate progress  Refine process  Identify practice variability  Foster sustainability Check & Analyze  Unit-based data - Random chart audits Q 6 months - Case studies  Staff practice audits  Bedside Handover observations  Frontline nurse feedback  Education reassessment survey Act Interventions:  Multi-faceted education  Champion cultivation  Coaching for staff & champions  Culture shift  Leadership support METHODOLOGY CONCLUSION OUTCOMES Intentional efforts towards sustainability made true culture change possible. It involved building staff competency and providing challenges and intellectual stimulation to maintain staff engagement. Consistent partnerships with a number of departments/ leadership was also a major factor in driving positive outcomes.2,3 NEXT STEPS Definitions: Screening Compliance defined as screening and documentation completed within 1 hour of start of shift, upon admission, and with change-of-condition. Screening Accuracy defined by 3-point criteria established by the Quality Department based on current sepsis protocol. Mortality rate defined by inclusion criteria of Age >65, sepsis-related diagnosis codes (ICD-10 or T8X), and admission to or discharge from 7 West. Cultivate additional unit champions Track utilization of UCLA Health’s new dynamic screening tool and its effect on screening compliance and accuracy Evaluate impact of system-wide adoption of dual-nurse sepsis screening during bedside handover Timeline Legend: 2015 Sepsis Milestone 2016 Sepsis Milestone 2017 Sepsis Milestone 2018 Sepsis Milestone Sepsis Chart Audit REFERENCES 1Nasa, P., Juneja, D., & Singh, O. (2012). Severe sepsis and septic shock in the elderly: an overview. World Journal of Critical Care Medicine, 1(1), 23-30. doi: 10.5492/wjccm.v1.i1.23. 2Kleinpell, R. (2017). Promoting early identification of sepsis in hospitalized patients with nurse-led protocols. Critical Care, 21(10), 1-4. doi:10.1186/s13054-016-1590-0 3Mukherjee,V., & Evans,L. (2017). Implementation of the surviving sepsis campaign guidelines. Current Opinion in Critical Care, 23(5), 412-416. doi:10.1097/MCC.0000000000000438 If you have questions or need assistance with this template, please contact: Jodie Pham at Ext. 98387 or jvpham@mednet.ucla.edu