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

5. ICU admissions
2012
2013
933
797
14.5% reduction in ICU admissions in 2013
Highest reduction in admissions from ED (↓21%)
Mostly due to implementation of NEWS
11% reduction in Sepsis admissions to ICU in 2013

6. 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

7. Governance Combined NEWS and Sepsis Group Driven by HMT
Terms of Reference adapted.
Amendments to existing hospital policies
Incident review template extended to include sepsis

8. Education Collaboration with NCHD leads Ward based training
Grand rounds
Weekly scenario-based training
Departmental meetings

9. Education Specific sepsis presentations for Medicine ED Anaesthetics
Paediatrics
Obstetrics

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

11. Incident Management Incident reporting template Specific learning
Feedback to all stakeholders
Identification of trends

12. Incident reporting

13. Auditing Share the workload Students Antimicrobial Pharmacists
Practice Development
Develop audit tools that will produce useful data

14. Audit Findings Sepsis documentation Compliance with Sepsis 6
Antimicrobial Stewardship
ICU admissions
Feedback provided
Action plans
Quarterly newsletter

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)

17. 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

18. Recognise your successes
Feedback to staff
Newsletter
MUH Quality & Patient Safety Symposium
National Patient Safety Conference
International Forum on Quality and Safety in Healthcare, Gothenberg 2016

19. The future Development of Group policies Blended learning
Sepsis e-learning module
Auditing
Pre-hospital/Primary care training
Public education

20. Future Challenges
Sustaining progress to date
Documentation
Auditing

21. Innovation
Could we save 150 lives in 150 days?

22. Innovation

23. 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. 23

24. Thank You