1. 1 Sepsis Management National Clinical Guideline No. 6 Implementation at Wexford General Hospital – October 2015 Shelagh Twomey, Quality & Safety Manager

2. Wexford General Hospital - Profile Part of Ireland East Hospital Group (IEHG); Provides acute service to County Wexford and some services to Waterford, Kilkenny, Carlow and Wicklow; Number of beds: 242 (209 in-patient/33 day); New ED in 2014; New Delivery Suite and Obstetric OT – 2015; Clinical Staff – 500 approximately.

3. Sunny South East

4. Commitment – getting started Presentations x 2 – January 14 th 2015 by Dr Vida Hamilton (attendees: 95+37=132) Meeting with Senior Management, (GM, CD, DON&M) to secure commitment; Governance: – Clinical Director/corporate lead; – Eilis and Shelagh – change agents – establish sepsis implementation group; – monitor progress via Quality and Safety Executive. Clinical champions – nominated by CD. 4

5. January 14 th 2015, WGH 5

6. What happened next? Clinical Director nominated clinical champions and letters outlining role sent – (education, lead) Await final versions of national forms; Sepsis Guideline flagged at meetings; Dr Vida Hamilton met potential Sepsis Implementation Group members on Tues, June 30 th – update and increase readiness; Sepsis Implementation group – first meeting September 1 st. 6

7. WGH Sepsis Implementation Group Clinical Director; Consultant Geriatrician; Emergency Consultant; Obs and Gynae Consultant; Practice Development; Quality & Safety Manager. Clinical Nurse Manager Grade III – Emergency & AMAU; Peri-operative; Medical; Director of N & M; ADON x 2; 7

8. 8 Resources and Education strategy Standardised ‘Sepsis Implementation’ presentation; Made link with Early Warning Score documentation; Sepsis Folder for all ward areas (bar MAT and Paeds) Sepsis algorithms – laminated A3 for clinical areas; Sepsis Pathways/Forms provided as handout at each session – ‘know what is on the form’; Local Anti-microbial guidelines; Sepsis Cards; Shared Folder for all WGH users – ‘Sepsis’ Most effective resource by far – the Rory Staunton Video Clip

9. Rory Staunton Video Clip – ‘A Hidden Crisis’ 9 http://rorystauntonfoundationforsepsis.org/about-rory-staunton/videos /

10. WGH Sepsis Folder National Guideline; List of Resources; List of iSTAT machines; Sepsis Group Membership; WGH Powerpoint; Sepsis Pathway (laminated). 10 Antimicrobial Guidelines for Acute Hospitals in South East, July 2015

11. Communication and Education Communication Blitz clinical staff – emails, posters, reminders, flyers, leaflets 10 sessions Sept and early Oct Doctors/nurses/HSCPs – together! 53% of clinical staff attended; Ward based sessions – CNM3s/ADONs; Each session: Rory Staunton Clip & Sepsis Powerpoint – Sepsis Pathway as handout. 11

12. 12 Implementation proper When? From Monday 5 th October, 2015… What? Sepsis Pathway for adult in-patient – all adult in-patient areas (bar Maternity and Paediatrics); Sepsis Pathway - patient presenting to ED. Feedback so far – forms being completed; ED nurses say pathway improves care; not being filed chronologically in HCR; one ICU nurse’s experience

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15. Some of our learning… Use national forms – get your Professional Print done early; Arrange for the forms to be punched! Involve night staff/ADON etc; Secure Medical Grand Rounds slot; Get clinical staff together for education! Ensure NCHDs get communications; ISBAR – ensure message of good quality.

16. 16 Learning - ISBAR Identify Identify: Yourself, Doctor, Patient Situation Why are you calling? (Identify your concerns) Background What is the relevant background? Assessment What do you think is the problem? Recommendation What do you want them to do?

17. Next Steps….. Monitoring and audit

18. Closing Thought….. ‘A smooth sea never made a skilful sailor…..’