Early Recognition and Management of Sepsis for HHS Meeting 4 Pat Posa RN, BSN, MSA, CCRN-K, FAAN Quality Excellence Leader SJMHS

Early Recognition and Management of Sepsis Welcome Program design Evidence-based and best practice education and training on protocols and tools necessary for early recognition of sepsis Interactive and integrated team approach with all health professionals Case-based approach Utilizes Performance Improvement Plan Includes home health agencies and discharging facility Required data collection over the period of the improvement project and beyond and includes how to track and trend the data

Early Recognition and Management of Sepsis Results: participating agencies implementing a sepsis protocol such that: Improved screening and identification of septic patients receiving home health services Improved identification of patients with sepsis Improved early interventions for patients with sepsis Reduced admission or readmission (30 and 90 days) Reduce the severity of sepsis when admission is required Assessment of current infection prevention practices for pneumonia, UTI’s and wounds Implement one infection prevention practice to close the gap between current state and best evidenced based practice for each infection Reduce mortality rates for those with sepsis (save lives) Agency Expectations: Implement sepsis screening tool and treatment protocols as provided in Early Recognition and Management of Sepsis Program Participate in monthly learning sessions Participate in a coaching call between session 1 and 2 Submission of process data

Program overview Pre-work prior to first session (watch a video) 3 in-person 90 minute session (consecutive months) 1 virtual 60 minute session One coaching call between session 1 and 2

What We Did Last Meeting Review homework related to implementation and auditing of sepsis screening Discuss infection prevention strategies for PNA, UTI and wounds Reviewed homework: Perform current state assessment on PNA, UTI and wound infection prevention Complete sepsis screening audits

Agenda for Today’s Meeting Review results of the current state assessment on PNA, UTI and wound infection prevention Discuss how the sepsis screening implementation is going and the results of the sepsis screening audits Review ongoing data submission process

Wound: Current State Assessment Prevention Practices Current Policy or Procedure in Place Audit 5 patients to see if compliant with policy Clinical staff wound care training (agency) Policy/Procedure: Proper hand hygiene Policy: Proper dressing change technique (incl. cleansing) Procedure: Proper nutrition screening and requirements identified (incl. hydration) EB dressing selection Clinical indications for obtaining a wound culture Pressure Ulcer Screening Skin impairment prevention plans in place Proper identification of support surface(s) Patient and caregiver education plans in place Use of wound care certified or trained professional* Professional wound committee* *Recommended but not required

Current State Assessment related to PNA Prevention Practices Current Policy in Place Audit 5 patients to see if compliant with policy Proper hand hygiene Comprehensive Oral Care Prevention of Aspiration Swallow screens Proper positioning during eating/feeding and sleep Mobility/ Lung expansion (up at least 1/day) Adequate nutrition (consumed >50% of diet)

Current State Assessment Related to UTI/CAUTI Prevention Practices Current Policy in Place Audit 5 patients to see if compliant with policy Proper Hand Hygiene   Without Indwelling Catheter: adequate fluid so urine is light and clear Appropriate toileting (emptying bladder every 2-3 hrs) Incontinence management With Indwelling Catheter: Aseptic technique followed during insertion Daily catheter care Catheter secured Closed system No dependent loops Catheter bag not on floor

Round Robin Review results of the current state assessment on PNA, UTI and wound infection prevention What gaps did you identify? What are your strategies to close the gaps? Discuss how the sepsis screening implementation is going and the results of the sepsis screening audits

Ongoing Data Submission Process Submit excel spread sheet to MPRO on the 15th of the month for the prior month’s audits Use this email address _______________

Sepsis Early Recognition Action Plan

Sepsis patient education toolkit

Sepsis Audit Sepsis screening compliance rate MEASURE NAME PERFORMANCE REVIEW MEASURES MEASURE DEFINITION/FORMULA (NUMERATOR/DENOMINATOR) Sepsis screening compliance rate Percent of unique patient visits where the SEPSIS screening tool was performed (performed 1 day per week, randomly) Numerator = Number of unique patient visits where the SEPSIS screening tool was performed Denominator = 30 Residents screened correctly using sepsis screening tool Percent of unique patient visits where the SEPSIS screening tool was performed accurately and reliably i.e. the screening tool was done correctly in a standardized format Numerator = Number of unique patient visits where the SEPSIS screening tool was performed correctly Denominator = Number of unique patient visits that were audited for SEPSIS screening accuracy (min=5)

Thank you for your hard work and dedication to preventing infection and sepsis in the people we care for