1. MSC Confidential Take the Shock Out of Sepsis

2. MSC Confidential Why Use Simulation?

3. MSC Confidential 3 Simulation in Aviation

4. MSC Confidential Miracle on the Hudson

5. MSC Confidential © Medical Simulation Corporation 2009 A Changing Landscape

6. MSC Confidential On-Line Course Didactic Review Simulation Debrief Blended Learning

7. MSC Confidential Understanding the Guidelines Standardized Metrics Individualized Feedback Putting the Guidelines into Practice The Application of Simulation

8. MSC Confidential MSC QI Program Components Pre and Post course knowledge assessment & confidence survey  45% Increase in Confidence  27% Increase in Consistency of Responses

9. MSC Confidential MSC QI Program Components Online Course

10. MSC Confidential MSC QI Program Components Educator facilitated review of online content Educator review of hospital specific policies and procedures

11. MSC Confidential Educator-facilitated simulation & debrief: 2-4 scenarios Includes an element of stress and/or real patient stories Process and clinical elements included MSC QI Program Components

12. MSC Confidential Metric Reports MSC QI Program Components 63% 82% 95%

13. MSC Confidential Simulation Validation Participation in a sepsis simulation training exercise resulted in Emergency Med Residents (n=20) taking more appropriate and immediate action in administering evidence-based care to patients. 7 Following simulation training, participants noted improvement in confidence levels in managing patients with severe sepsis and septic shock. 8

14. MSC Confidential 14 Sepsis Program Benefits Documentation of staff competence and compliance Consistent training across all staff Integration into hospital quality improvement programs Program based on guidelines, tools and research from: Surviving Sepsis Campaign Institute of Healthcare Improvement (IHI) Latest research studies related to the treatment of sepsis

15. MSC Confidential Sepsis Program Objectives 1.D ESCRIBE THE DIFFERENCE BETWEEN SEPSIS, SEVERE SEPSIS AND SEPTIC SHOCK 2.I DENTIFY SIGNS AND SYMPTOMS OF SIRS 3.D ISCUSS ASSESSMENT FINDINGS CORRELATED WITH PATIENTS WHO ARE AT INCREASED RISK FOR SEPSIS (I NDEX OF S USPICION ) 4.I DENTIFY SIGNS AND SYMPTOMS OF TISSUE HYPOXIA 5.I DENTIFY SIGNS AND SYMPTOMS OF ORGAN DYSFUNCTION 6.D ISCUSS FLUID RESUSCITATION RECOMMENDATIONS AND GOALS ACCORDING TO THE S URVIVING S EPSIS C AMPAIGN GUIDELINES 7.I DENTIFY CORRECT EARLY IDENTIFICATION AND TREATMENT RECOMMENDATIONS ACCORDING TO THE S URVIVING S EPSIS C AMPAIGN GUIDELINES 8.D ISCUSS RATIONALE FOR SEPTIC SHOCK TREATMENTS

16. MSC Confidential Epidemiology Sepsis is the leading cause of death for critically ill patients in the United States It is the tenth most common cause of death overall It accounts for 1-2% of all hospitalizations and for 25% of ICU bed utilization Projection for 2020 is 1,100,000 new cases of sepsis

17. MSC Confidential 17 IHI Surviving Sepsis Process Measures Process Measure Goals Timing of Blood Cultures Timing of Antibiotics Central Venous Pressure Central Venous Oxygen Saturation Low-Dose Steroid Administration Drotrecogin Alfa (Activated) Administration Glycemic Control Inspiratory Plateau Pressure Reliability

18. MSC Confidential Mortality As sepsis progresses, mortality increases 20% for sepsis 40% for severe sepsis Greater than 60% for septic shock

19. MSC Confidential Sepsis Audience Early Responders ER Med/Surg Nurses Acute Care ICU Medical Staff Residents Fellows Multi-Disciplinary Team Integration

20. MSC Confidential Sepsis Continuum SIRS A physiologic response of the endocrine axis and immune systems Sepsis SIRS + a known or suspected infection Severe Sepsis Sepsis + acute organ dysfunction Septic Shock Severe sepsis + refractory hypotension

21. MSC Confidential Simulation and Sepsis A physiologic response of the endocrine axis and immune systems Participants must determine if their patient meets SIRS criteria in a dynamic setting Is their hear rate > 90 Is their respiratory rate > 20 Do they have a temperature Has their WBC value changed SIRS

22. MSC Confidential Treatment Start Sepsis Resuscitation Bundle Draw lactate Draw blood cultures Administer broad spectrum antibiotics If hypotensive or lactate > 4 administer 20ml/kg fluid bolus over 30 min Insert central line with ScvO2 and CVP monitoring capabilities Simulation and Sepsis

23. MSC Confidential SIRS + a known or suspected infection Participants must determine if their patient is septic Thorough history and physical assessment Asking questions/hands on assessment What is their index of suspicion Sepsis Simulation and Sepsis

24. MSC Confidential Treatment Diagnosis of source Line insertion Appropriate admission orders (acute care setting) Time appropriate interventions Antibiotic administration Fluid administration Simulation and Sepsis

25. MSC Confidential Sepsis + acute organ dysfunction Participants must recognize indications of organ failure Selecting and reviewing appropriate labs Recognizing dynamic patient condition changes through continuous assessment Assessing CXR, Echocardiograms and other diagnostic tools Severe Sepsis Simulation and Sepsis

26. MSC Confidential Treatment Appropriate interpretation of lab values Were correct labs drawn Recognition of organ failure Increased respiratory support Decreased UOP despite adequate fluid administration Decreasing LOC Simulation and Sepsis

27. MSC Confidential Severe sepsis + refractory hypotension Participants must recognize the signs and symptoms of septic shock symptoms Decreasing blood pressure Insertion of appropriate invasive monitoring lines Use of appropriate pharmacological medications Knowledge of the management bundle Septic Shock Simulation and Sepsis

28. MSC Confidential Treatment Participants must recognize refractory hypotnesion Implementation of appropriate vasopressor therapy Norepinephrine, Dopamine, Understanding of ScvO2 and CVP values Inotropic support Dobutamine Implementation of the management bundle Corticosteroid administration rhAPC administration Glucose control Protective ventilation Simulation and Sepsis

29. MSC Confidential Test Your Knowledge SimSuite Sepsis Program Pre-Online Course Knowledge Check Available to Laerdal SUN Attendees and their Hospital Staff

30. MSC Confidential Conclusion Open for discussion and question