Webinar | Beating the Clock to Stop Sepsis in One Hour

Q&A

During the presentation of our webinar, Ellen Noel, MN, RN, CPHQ, answered a few questions from participants:

Q: What is the best way of ensuring that antibiotics are administered within an hour?

A: Antibiotics within 1 hour rely on 3 important steps.

  1. Early RN recognition of sepsis and rapid initiation of the nurse initiated protocol which we call Sepsis Power Hour.
  2. Just in time physician notification that Sepsis Power Hour treatment has begun so confirmation of treatment and antibiotics are ordered as soon as sepsis is confirmed.
  3. Concurrent pharmacy notification of antibiotic need without delay.

Designing a process that allows for synchronized and parallel work to be done in a standardized way decreases the time to treatment and saves lives.

Q: What steps did you take to engage physicians in supporting a nurse driven power hour? Was physician autonomy a challenge?

A: Physician engagement and leadership is essential to a successful sepsis campaign. Our accelerated success relied on identifying sepsis prevention as an organizational quality goal, ensuring executive sponsorship and being explicit on which physicians and nurses were on point to lead process change. Physicians are generally interested in collaborating to improve care. Physicians and the nurses leading this work were respected colleagues and spent many hours connecting with their peers, sharing progress and feedback and using our improvement method. Sepsis prevention sustainability depends on a system approach and a clear method to improve is critical to effect change.

Q: What is the most effective screening tool utilized in ICU versus non-ICU areas?

A: We used Surviving Sepsis Campaign guidelines, which is the gold standard for evidenced based sepsis prevention.

Q: What is the single most enabling action a team can perform to improve their performance?

A: As the only healthcare system with over 16 years’ experience in applying Lean to improve the reliability of our processes and our outcomes, we have found that a single improvement method that activates teams to engage and learn through change is imperative. Along with leadership behaviors, the practices of lean science, when executed correctly, encourage team activation, sepsis order set use and protocol adoption. Adopting a lean methodology has allowed us to accelerate our work in Sepsis and many other areas. empowering clinicians to design processes that optimizes time to treatment and rid the system of delays.

Q: Do you have a “Sepsis Response Team” that responds upon positive ID notification similar to a “Rapid Response Team?”

A: Our code sepsis response is part of our rapid response structure. A patient who screens positive will receive a coordinated team response that initiates next steps for treatment without delay. Interestingly, by implementing the sepsis power hour our rapid response data has shown that over time the volume of overall rapid response calls decreased from 120 to 35 per month. Imagine being able to use the healthcare team in a preventative way when the patient has the best chance for survival. This improvement shows that early detection, coupled with timely, synchronized response, can improve the way we use our people to deliver care; and that directly translates to our patients.

Q: What EHR do you use, and how have you exploited it to help with rapid treatment initiation and care continuity?

A: A rapid sepsis response process is ultimately reliant on technology to get to zero defect delivery. Improving information flow with technological advances and has truly helped us get to the finish line. Virginia Mason is unique however in that our staff studied the medical flows of sepsis patients using Lean before technology application. This ensures that information waste is eliminated and standard work that supports the human and machine interface is present so reliability is achieved.

Q: How would you recommend implementing a nurse empowered approach in state that has a stricter nurse practice act around protocols?

A: First, understand your states Registered Nurse scope of practice regulations. If nurse initiated order sets are allowed in your state, follow national guidelines for creating, approving and maintaining safe practices. There is a prescriptive approach to organizational policy for nurse-initiated orders. Physician oversite and nurse training and competency are key. JCAHO and AHRQ are good resources to start with.

Q: Can you provide us with your current forms, flowcharts, and checklists so we can implement this process at our hospital?

A: The Sepsis Power Hour method includes the same essential tools and strategies implemented at Virginia Mason. By partnering with us to effectively address sepsis in your hospital, your health care team can benefit from our extensive experience in creating standardized processes, optimizing flow, and preventing mistakes.

Our sensei provide the intensive coaching and training needed to ensure your team is empowered to rapidly address the early detection of sepsis the same way, every time, for every patient.

Ellen Noel, MN, RN, CPHQ, is a transformation sensei at Virginia Mason Institute. Her in-depth knowledge of clinical processes, team development, health care outcomes and regulatory performance provides a solid foundation for an extraordinary customer learning experience. Prior to her work at Virginia Mason Institute, Ellen worked as an adult clinical nurse specialist and director of quality and safety. As an improvement leader, she led system-level improvement work in medication safety, nursing and care team workflow efficiencies, pain management and patient safety. Ellen is a Kaizen Fellow graduate certified in the Virginia Mason Production System®. She is also a Certified Professional in Healthcare Quality.

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