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Sepsis-Presentation.pptx
- 1. A Sepsis Quality Improvement project Meeting the one-hour target Diana Marujo Senior Charge Nurse / Emergency Nurse Practitioner / Sepsis Lead Emergency Department Wexham Park Hospital Oxford
- 2. Lay definition of sepsis: the Merinoff definition: Sepsis is a life-threatening condition that arises when the bodys response to an infection injures its own tissues and organs. Professional narrative definition of Sepsis: Singer M et al (Sepsis-3): Sepsis is characterised by a life- threatening organ dysfunction due to a dysregulated host response to infection. Definition of septic shock: Singer M et al (Sepsis-3): Septic shock is a subset of sepsis where particularly profound circulatory, cellular and metabolic abnormalities substantially increase mortality. Table 1: Sepsis incidence in England (no. of episodes per year as reported by the Health and Social Care Information Centre (now NHS Digital) Year 2010-11 2011-12 2012-13 2013-14 2014-15 Number 91,881 101,015 114,285 122,822 141,772 SEPSIS CLAIMS MORE LIVES THAN LUNG CANCER, AND MORE THAN BOWEL, BREAST AND PROSTATE CANCER COMBINED (46,000-67,000) The Cost of Sepsis YHEC estimated, given that there are at least 250,000 cases of sepsis every year, that sepsis costs the NHS between 贈1.5 and 贈2 billion each year, and our wider economy at least 贈11 billion and possibly as high as 贈15.6 billion. The Sepsis Manual Sepsis UK Trust 4th edition 2017 - 2018 250,000 year UK
- 3. The Sepsis Manual Sepsis UK Trust 4th edition 2017 - 2018
- 4. WPH ED Sepsis Screening Tool WPH ED Suspected Neutropenic Sepsis Tool
- 5. What was working? Screening (after Patient First) What needed to be improved? Screening was poor (before PF) Documentation using Sepsis Screening Tool Sepsis not identified Sepsis identified but not escalated Sepsis escalated but not treated within 60 minutes
- 6. Sepsis Lead Handovers / Board rounds ED Sepsis Newsletter Sepsis Champions ED Sepsis Study Day Sepsis Bleep Team
- 7. Emergency Department Wexham Park Hospital Sepsis Bleep Team Pathway 2019 Sepsis Team: HCA: IV access + bloods Nurse: Sepsis Screening Tool + Antibiotics Doctor: RAT 3666 4240 Hospital No. # NEWS 5 Chemo 6/52
- 8. 0% 20% 40% 60% 80% 100% Apr-19 May-19 Jun-19 Jul-19 Aug-19 Sep-19 % Sepsis Screening ED CQUIN 0% 20% 40% 60% 80% 100% Apr-19 May-19 Jun-19 Jul-19 Aug-19 Sep-19 % Antibiotics in 1 hour ED CQUIN June 2019: From 57% in May to 82% July 2019: From 82% in June to 85% August 2019: From 85% in July to 90% September 2019: Maintaining 90% Screening in the future: Introduce pop-up window in Symphony for chemo patients and NEWS5 Create electronic Sepsis Screening Tool
- 9. 0 20 40 60 80 100 Jan-19 Feb-19 Mar-19 Apr-19 May-19 Jun-19 Jul-19 % FBC POC <45 min 0 20 40 60 80 100 Jan-19 Feb-19 Mar-19 Apr-19 May-19 Jun-19 Jul-19 % Antibiotics <60 min NS From February to April 2019: News programme Symphony New Department EAC What needed to be improved? Walk-in patients Between 30-40 patients a month Only 13%-19% are neutropenic
- 11. The Sepsis Bleep Team is showing positive results. More than 80% of the identified septic patients are now receiving antibiotics within 60 minutes. Also more than 80% of the suspected neutropenic patients are NOT receiving unnecessary antibiotics. Overall, by introducing the Sepsis Bleep Team deteriorating patients are being prioritise, rapid assessment and treatment is being provided along with good antibiotic stewardship.
- 12. Continue awareness and training Improve documentation Improve Screening and Action Tool Antibiotic stewardship Work together with multidisciplinary teams