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

2. 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

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

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

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

6. 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.

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

8. 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

9. “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

10. Power Hour Data (n=254)

11. 85 Patients Power Hour Data (n=254) New antibiotic orders
Don’t Wait, Initiate!
Sepsis Power Hour
New antibiotic orders
85 Patients

12. Power Hour…Does it work?

13. Reduction in RRTs

14. 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
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.

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
Dr. Corliss

17. Emergency Nursing

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
Elissa

19. ED Sepsis Evaluation Question (ED Triage)
Elissa

20. ED Nursing Best Practice Advisory
Elissa

21. Elissa

22. ED → Admission
Sepsis 4 Life Worksheet
Dallen

23. Dallen

24. Dallen

25. Dallen

26. Blow up comment in previous slide
Dr. Corliss

27. Dr. Corliss

28. Dr. Corliss

29. Dr. Corliss

30. Inpatient Nursing
Elissa and Lorri

31. Inpatient RN Screening Tools (in EPIC)
Elissa

32. WMH SEP-1 Nursing Education
Lorri

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

34. Lorri

35. SEP-1 - Data
Dr. Corliss

36. Questions?