Hi Lisa:
The mortality is expected to decrease as the bundle complaince increases.
Unfortunately, it is a painstaking process to hardwire a sepsis improvement
program. Ordersets alone will not change culture.
Here are some strategies that have worked for some of our hospitals:
1. Consistent screening for SIRS ED in triage.
2. Mandatory use of overhead sepsis alerts when SIRS + organ dysfunction is
recognized.
3. Protocolized fluid boluses (weight based and with pressure bags)
4. Giving "ownership" of the bundle to a dedicated team, e.g., vascular access
(PICC line) nurses.
5. Pharmacy driven antibiotic delivery upon activation of a sepsis alert
6. Rapid (within 30 minute of sepsis alert) admission to ICU with bedside
report in cases of septic shock.
7. Issuance of feedback letter to MDs through the quality department within 3-5
days if sepsis is not treated per standards.
8. An earnest call for stronger leadership and action (in process)
Thank you.
Imran Aurangzeb, MD, FCCP
For individuals, character is destiny. For organizations, culture is destiny. —
Tony Hsieh
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________________________________
From: Lisa Dumont <[email protected]>
To: "[email protected]" <[email protected]>
Sent: Monday, July 8, 2013 8:29 AM
Subject: [Sepsis Groups] how to improvement mortality with lactic acid greater
than 4
Dear list-serv members,
Currently our heath care system is struggling to reduce our mortality with
lactic acids >4. Our overall mortality is 23.7% with a target goal of 14.1%; we
are improving on this. However, we can’t seem to reduce our mortality rate with
lactic acids of 4 or greater. Currently, in this range, our system has a 39.3%
mortality with one of our facilities running in the 60% range. I am wondering
how others are dealing with this and I am looking to see if others have seem
improvements on specific strategies. For background purposes, we began our
program Jan 2013, have implemented sepsis order sets (not great compliance), ED
screening tool, and an inpatient acknowledgement screen assessment. This last
month, we only had 3 RRTs related to sepsis. We do have physician champions and
I am sending good cases and “need improvement” emails to leadership. Looking
for creative methods to reduced our mortality. Any suggestions is greatly
appreciated.
Lisa Dumont MSN-sepsis coordinator
Southcoast Hospital System
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