Improving Severe Sepsis/Septic Shock Screening and Accuracy Susan

Improving Severe Sepsis/Septic Shock Screening and Accuracy Susan

Improving Severe Sepsis/Septic Shock Screening and Accuracy
Susan Abrams RN-BC, BA Carson Del Greco Julie Gaspar RN, PCCN Danielle Park RN, BSN, CCRN Summer Gupta
RN, MSN Lisa Harrison RN, BSN Mary Lawanson-Nichols RN, MSN, NP, CNS, CCRN Trudy Rhodes RN Mackenzie
Roesti RN MSN, CCRN Patty Sheehan MN, CNS, RN, CCRN-K Kimberly Ternavan RN, MS/MBA, NE-BC
UCLA Health, Ronald Reagan Medical Center/Santa Monica Hospital

Currently, 33% of Santa Monica Hospital (SMH)
patients have a nurse sepsis screen completed
within one hour after time of presentation
(TOP) with 38% accuracy. At Ronald Reagan
Medical Center (RRMC), only 39% of patients
are screened within one hour after TOP with
44% accuracy. These deficiencies cause delayed
implementation of the sepsis treatment
bundle and can be linked to increased
mortality, length of stay, and cost.

Current State
- CMS reviewed charts with TOP in the
inpatient areas between March Dec 2016
- Reviewed for accurate and complete
screening within one hour after TOP
- Sepsis Nurse Roles/Responsibilities (SMH)
Started December 2017
Identifies pts with elevated MEWS
and reviews charts for possible
Severe Sepsis/Septic Shock
Visits primary RN to discuss pt
status, screening, and plan of care
- RRMC did not have a role dedicated to sepsis
surveillance; however they have a clinical
surveillance team that monitors clinical
deterioration using the MEWS tool.

Objectives
50% screening within one hour of TOP with
50% accuracy by June 30, 2017
62% screening within one hour of TOP with
62% accuracy by Dec 31, 2017
75% screening within one hour of TOP with
75% accuracy by March 31, 2018

Results

Solutions

Problem Statement
Root Cause

Tested Solution

Responsible

Go-Live/
Completion

Accuracy and Timeliness:

RRMC

Q1/Q2
2017

Q3/Q4
2017

Q1 2018

Organ dysfunction of previous shift is
unknown

Modify screening tool to allow RN
to choose organ dysfunction

IT workgroup

04/05/2017

Organ dysfunction is not recognized

Modified screening tool that autopopulates vital signs and lab values

IT workgroup

11/15/2017

Timeliness

1 /10 = 10%

1 /9 = 11% 1 /4 = 25%

Insufficient report r/t increased RN
accountability

Dual nurse screening at handoff

All / RN
Champions

11/15/2017

Accuracy

0 /1 = 0%

0 /1 = 0%

Unable to dive deep in chart r/t
increased pt acuity

Dual nurse screening at handoff

All / RN
Champions

11/15/2017

RN does not recognize urgency to rescreen r/t misunderstanding of patho
and mortality data

Education Use of MEWS scores
to prompt re-screening of pt.
(5MN and 7W)

Julie, Patty,
Mackenzie,
Susan

08/31/2017

SIRS and organ dysfunction attributed
to causes other than infection r/t RN
concern of provider pushback

Deferred

Deferred

Deferred

Misconceived perception of
seriousness of organ dysfunction

Education Use of MEWS scores
to prompt re-screening of pt.
(5MN and 7W)

Julie, Patty,
Mackenzie,
Susan

08/31/2017

Sepsis Dynamic Nurse Screening Tool

SM

Q1/Q2
2017

0 /1 = 0%

Q3/Q4 Q1 2018
2017

Timeliness

11 /19 = 58% 6/11 = 55% 1/ 3 = 33%

Accuracy

5 /11 = 45%

5 /6 = 83% 1 /1 = 100%

Mortality Index:
Severe Sepsis/Septic Shock Not
Present on Admission (POA)
10/2015 03/2018
RRMC and SMH

Next Steps
Due to our interventions, nurse screening
accuracy and timeliness have improved at
SMH, but we have not seen this improvement
at RRMC. Overall, we have seen a reduction in
the mortality index with severe sepsis/septic
shock not POA. We continue to create
educational opportunities for nurses by
holding four hour mandatory education
classes related to the role of nurses and sepsis
care. Completion will occur by March 2019.
We will continue to monitor/evaluate
timeliness and accuracy. In addition, our
workgroup continues to modify and improve
the dynamic screening tool to make it user
friendly and clear for all nurses.

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