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

2. © 2014 Virginia Mason Medical Center The Virginia Mason Sepsis Bundle 2 SIRS any 2 TEMP > 38.0, < 36.0 HR > 90 RR > 20 WBC > 12, < 4 > 10% bands Sepsis SIRS + Possible Infection Severe Sepsis 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

3. © 2014 Virginia Mason Medical Center Standardization and Reliability Standard criteria to identify the condition Order sets Checklists Bundles and kits Visual Controls Intake huddles Standard work 3

4. © 2014 Virginia Mason Medical Center Why focus on low grade sepsis? 4 Septic Shock Hypotension 1817 Deaths @ Kaiser Permanente Northern CA Liu Et. Al. JAMA July 2014

5. © 2014 Virginia Mason Medical Center Do it Faster! 5 “Can that be done?” < 1 hour

6. Sepsis Power Hour = Early Recognition and Treatment in the Hospital Nurse Leads Sepsis Power Hour = Early Recognition and Treatment in the Hospital Nurse Leads

7. © 2014 Virginia Mason Medical Center RN Initiated Bolus for low BP 7 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

8. © 2014 Virginia Mason Medical Center Sepsis Power Hour: Nurse Leads 8 RN Work: Identify Sepsis Check Lactate within 10 min Check Blood Cultures Start 500cc fluid bolus MD Work: Confirm Sepsis Start Antibiotics Complete 2L fluid bolus < 30mins < 60mins Pharmacy Work: Prioritize Antibiotics Dose and Prepare STAT Hand-Deliver to patient’s location

9. © 2014 Virginia Mason Medical Center “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 9

10. © 2014 Virginia Mason Medical Center Power Hour Data (n=254) 10

11. © 2014 Virginia Mason Medical Center Power Hour Data (n=254) Don’t Wait, Initiate! Sepsis Power Hour 85 Patients

12. © 2014 Virginia Mason Medical Center Power Hour…Does it work?

13. © 2014 Virginia Mason Medical Center Reduction in RRTs

14. © 2014 Virginia Mason Medical Center Sepsis Deaths

15. 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 15

16. 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 16

17. Emergency Nursing 17

18. 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 18

19. 19 ED Sepsis Evaluation Question (ED Triage)

20. ED Nursing Best Practice Advisory 20

21. 21

22. ED → Admission Sepsis 4 Life Worksheet 22

23. 23

24. 24

25. 25

26. Blow up comment in previous slide 26

27. 27

28. 28

29. 29

30. Inpatient Nursing 30

31. Inpatient RN Screening Tools (in EPIC) 31

32. WMH SEP-1 Nursing Education

33. Quality Nursing Abstraction Tool for Concurrent Review 33

34. 34

35. SEP-1 - Data 35

36. Questions? 36