1. SEPSIS Team Striving for Excellence

2.  Columbus, GA  376 Bed facility  Religious affiliated  Community owned  www.wecareforlife.com www.wecareforlife.com St. Francis Hospital

3.  Identify signs and symptoms of Sepsis.  Identify strategies to improve care for Sepsis Patients Objectives

4. SIRS (Systemic Inflammatory Response Syndrome) – A clinical response to a nonspecific insult of either infectious or noninfectious origin. Emedicine.medscape.com Sepsis – SIRS in the presence of infection (Lilly) – Process of malignant intravascular inflammation. Exaggerated response of the immune system, exhibited by widespread inflammation – Causes endothelial damage; can progress to multiple organ system dysfunction UpToDate SIRS & Sepsis

5.  Sepsis strikes 1,000,000 people each year in U.S.  28-50% of these people die (~200,000)  Far more than the number of U.S. deaths from prostate cancer, breast cancer and AIDS combined  ~1400 deaths per day in the world Surviving Sepsis Campaign Statistics

6.  Failure of Immune Cascade (widespread inflammation)  Clotting Cascade: Abnormal Coagulation  Hypoxia (lack of O2)  Hypoperfusion (decreased blood flow to organs)  Endothelial Damage (vascular damage/collapse— shock)  Lactate buildup Sepsis: What goes wrong?

7.  Temperature: > 100.4°F or < 96.8°F  Heart Rate > 90  Resp. Rate > 20 (or PaCO2 <32)  WBC > or = 12,000 or < 4000  (Bandemia: > or = 10% Bands)  (Bands: Immature Neutrophils) SIRS Criteria

8.  Procalcitonin (PCT)  CRP  Interleukin-6 (IL-6)  Lactate There are no true biomarkers for sepsis. Some research suggests PCT has > sensitivity/specificity. Otterman, M (Medscape) 2013 Bio-Markers for Sepsis??

9.  Mild  Lactate < 2mMol/L  Moderate  Lactate > 2mMol/L or organ dysfunction  Severe  Lactate >4mMol/L  Admit to Critical Care Unit Mild, Moderate, Severe Sepsis

10. Sepsis Team Progression  2009  Expectations set to reduce Sepsis mortality (higher than expected)  2010  Combined Pneumonia & Sepsis teams 2011  set as Organizational strategic goal to reduce Sepsis mortality rate  Sepsis Team formed  2012  Identified Opportunities for early goal directed care education  2013  Prioritized utilization of Sepsis orders  2014  Implemented Antibiotic Stewardship (72 hour reviews)

11. Slide 1 Our Team Mission  Provide Best Care  High quality  Disease focused  Evidence-based  Partnership  Patients/Families  Community  Physicians  Improve Sepsis Outcomes  Decrease LOS  Decrease Mortality

12.  Team Leader (Physician: Dr. Kevin King)  Admin Rep (VP Patient Care)  Physician Consultants (5 Physicians)  Multidisciplinary Team  Quality/Core Measure Reps  Nursing Leadership/Education  Case Management  Pharmacy/Respiratory/Laboratory  Clinical Applications/IT Our Team

13. The clock is ticking… Sepsis Mortality increases by 7% every hour if not treated appropriately Proper Antibiotic selection is crucial

14. Decrease in Mortality Rate = Lives Saved

15. Educational campaign  Nursing education  Nurses and Techs  Community education  Physician education  Physician Staff Services Waging War on Sepsis

16.  “Sepsis and My Big Sister”  A personal story by Tammy Gilliland, educator  “Waging War on Sepsis”  1 contact hour  Lecture  On-line education  Creative Educational Tools Nursing Education

17. Badge Buddies: FLOAT to Safety

18. Posters

19.  Community Brochure  Community Presentation  Nursing homes  Churches  Other hospitals  Home health agencies Community Education How many lay people can recognize the s/s of sepsis?

20.  National Sepsis Recognition Month - September  Personal Sepsis Recognition Day - April 20th  Anniversary of Tammy’s sister’s death Sepsis Awareness Day

21.  Hospital Wide Celebration  Cupcakes, Zero candy bars, & Lifesavers  Banners  Physician “Lunch & Learn” Lecture  “Waging War” Lectures (day/evening)  Information table with prize drawings  Public Prayers  Press Coverage (Local T.V. News) Sepsis Awareness Day Activities

22.  Learn Signs & Symptoms of Sepsis  Utilize Sepsis Protocol  Exercise Infection Control Sepsis War Bonds

23. Slide 23

24.  Sepsis Risk Assessment Tool  Paper form: Done on all direct admissions  Electronic Sepsis Screening (ED)  Lactate Point of Care Testing  Now in our ED  Sepsis Dashboard  Ongoing data collection  In use since 2011 The War Continues

25. Are You Smarter than a Fifth Grader…about Sepsis??

26. Stop Sepsis! Advice from a 5 th Grader Advice from a 5 th Grader:  Wash Hands  Get Flu Shots  Cover your Mouth  Get Healthy

27. Go Outside, Be Healthy! Wash Your Hands!!

28. And let us not grow weary of doing good, for in due season we will reap, if we do not give up. Galatians 6:9 Questions?