1. Ronán O Cathasaigh Mayo University Hospital

2. Mayo University Hospital
Part of the Saolta University Healthcare Group
Acute care to Mayo and parts of West Roscommon, North Galway and Sligo
Population of 130,552
306 in-patient beds
51 day beds
34,192 ED admissions in 2014
214 ICU admissions in 2014

3. Patient TM 1200: BIBA to ED from Home
Increased confusion, pyrexia and dyspnoea
1207 ED triage: Category 3
1222 ED NCHD
1232 IV fluids and oxygen
1244 1st dose of IV antibiotics
1250 Bloods sent including lactate & cultures
Fluid balance chart commenced
1300 Referred to Medical team
Discharged home after 6 days

4. How did we get here? Natural progression from implementation of NEWS
2012 Incidents of late identification and management of Sepsis in ED identified a need for improvement
In order to ensure a rapid response to cases of suspected sepsis: Education, Auditing, and an incident reporting system that can respond rapidly to adverse events involving sepsis management

5. Implementation of Sepsis National Clinical Guideline
Introduced in December 2014
National Sepsis Lead Visit
NEWS Governance Group extended to include Sepsis
Lessons learnt from NEWS implementation

6. Effective Implementation needs Effective Governance
Leadership
Clear structures
Terms of Reference
Teamwork and relationships
Communication

7. Leadership (contd.) Combined NEWS and Sepsis Group Driven by HMT
Terms of Reference adapted.
Amendments to existing hospital policies
Incident review template extended to include sepsis
GROUP POLICIES

8. 2. Patient & Public Involvement
Consumer participation and involvement
Patient advocacy
Complaints management
Open disclosure
Patient Information Booklet
Patient representation on HMT

9. 3. Risk Management Incident management Managing adverse events
Managing complaints
What is the specific learning?
Trends
Action plans
Incorporate into learning
Feedback to all stakeholders
4-hourly patient safety meetings
ED/Ward Safety huddles
How do we ensure a rapid response to suspected sepsis: 1. Education. 2. Audit 3. Incident reporting.

10. Incident reporting
Incident reporting can be a very bureaucratic process. It needs to be more responsive to encourage staff to report adverse events even if they themselves are involved.
Originators receive feedback. ‘Because of the IR that you completed this happened’.

11. 4. Clinical Audit Effectiveness
Hospitals that conduct research perform better

12. Clinical Auditing Share the workload Students
Antimicrobial Pharmacists
Practice Development
Develop audit tools that will provide useful data
Internal & External audit

13. What do we audit? Sepsis documentation Compliance with Sepsis 6
Antimicrobial Stewardship
ICU admissions
Feedback provided
Action plans
Time is not on your side: Ensuring that the right antibiotic is delivered quickly. Availability of GUH Guidelines. Education via Microbiologist and Antimicrobial Pharmacist
Antimicrobial stewardship audit.
Time is not on your side: Every minute counts. All incident reports contain a timeline to identify gaps in the administration of Sepsis 6
Findings: Too many interruptions: Nurses (and other healthcare professionals) are interrupted every 6 minutes.
Plan: Implement a CODE SEPSIS similar to other time sensitive emergencies such as STEMI or CVA

15. Audit Findings
Reduction of 6.9% in patients with Sepsis requiring ICU admission
Reduction in ALOS by 3 days
(Ref: HIPE, Health Pricing Office & ICU data)

16. Recognise your successes
Feedback to staff
Quarterly newsletter
MUH Quality & Patient Safety Symposium
National Patient Safety Conference
International Forum on Quality and Safety in Healthcare, Gothenberg 2016
Improvement methods not only education, audit and incident reporting but also promotion of successes, celebrating the small wins, aim for the small wins first and the bigger ones will follow.

18. World Sepsis Day Local media involvement 350 attended the event
Staff, patients, relatives and members of the public.
Presentation of audit findings
Promotion of achievements

19. 5. Staff Management Performance management All staff take ownership
Dashboards on individual wards
Sepsis is everyone’s business
Patient safety is everyone’s business

20. 6. Education Induction Competency assurance
Continuous Professional Development
Blended learning
E-learning programme
What are the roles of each HCP in the management of sepsis. Weekly scenario based training for ED & Medical staff clarify roles of individual staff members
Highlights gaps including interrupting the NCHD who is implementing Sepsis 6
We train staff that Sepsis is a medical emergency similar to Code STEMI, CVA

21. Education (contd.) Specific sepsis presentation for: ED Anaesthetics
Medicine
Paediatrics
Obstetrics: PROMPT course
Regular scenario-based training
Department specific training incorporates incident reporting trends i.e. poor documentation, not recording lactate
Training incorporates unique clinical issues with Department i.e. Obs/Gyn.

22. Education (contd.) Collaboration with NCHD leads Grand rounds
Induction
Ward based training
Departmental meetings
Interprofessional learning
WBT allowed me to monitor staff compliance and awareness of guidelines and to feedback from incidents in specific areas.
Gaps in performance during rotation of NCHDs. Group Sepsis leadsa may be able to address this given that most NCHDs rotate within the Group. Role of HR, More cooperation between group hospitals
Until consistent standard of training can be applied across all disciplines and specialities via the E-learning programme, we cannot monitor training levels. What is more important is the measurement of the patient experience

23. 7. Information Management
Reporting on performance
Information sharing
Metrics
Feedback to HMT and Ward based staff
Electronic information systems
EIS can contribute to audit in many ways:
Improving access to research evidence
Data collection
Prompting change through record templates
Enabling revised systems of care to be introduced
CERNER
B Ward MUH; Electronic data board; Training, Increasing awareness

24. Sepsis Documentation Remains challenging Auditing
Who completes the sepsis screening form?

25. The future Group Sepsis ADONs Development of Group policies
Blended learning
Sepsis e-learning module
Auditing
Pre-hospital/Primary care training
Public education
Review of National Clinical Guideline in 2017

26. Roles of each Healthcare Professional
Take ownership of the Sepsis Management Guideline
Not my guideline
Collective responsibility
Educating patients
IPC practices

27. Future Challenges Sustaining improvements to date
Continuing the audit cycle
Documentation
Innovation
Treat Sepsis as a medical emergency
‘Code Sepsis’
We can only improve the management of patients with sepsis by continuing the audit cycle, learn from others and incidents

28. Future Challenges
Pre-hospital implementation

29. Process Map for Implementation
1. Build core team
Sepsis core team
What is your current status?
EGDT gap analysis
Build project plan

30. Process Map for Implementation
2. Educate and communicate to organisation
Focussed education sessions
Sepsis education day

31. Process Map for Implementation
Apply process improvement techniques
Develop sepsis screening methods
Screening competencies
Validate methods
Data reporting according to hospital reporting mechanisms
Measure the outcomes

32. Innovation Could we save 150 lives in 150 days?
With so many NCGs in place 10 at the moment and more on the way, we must still allow/promote/encourage local innovation/entrepreneurship but do it in a standardised way and share what you have learnt
COMBINING PROTOCILISATION AND INNOVATION

33. Innovation

34. Sepsis 6- How hard can it be….?
The Sepsis 6 bundle is derived from the Surviving Sepsis Campaign evidence-based Guidelines for management of Severe Sepsis (Delinger et al., 2008). Derived from 24 hour and 6 hour bundles. 34

35. Thank You
Avoid interruptions when Sepsis 6/Code Sepsis being managed