VICU Participation in the Identification of Patients with Severe Sepsis Leah Borchardt, APNP, MSN, CCRN, TNS, Jeffrey Wegner, BSN, TNS, Barb Pritzl, BSN, RN & Denise Mandery, eCM Froedtert and the Medical College of WI, Froedtert Hospital, Milwaukee, WI 414.805.4050, [email protected]

Background and Significance: Sepsis is a clinical syndrome characterized by systemic inflammation due to infection. There is a continuum of severity ranging from sepsis to severe sepsis and septic shock. Over 1,665,000 cases of sepsis occur in the United States each year, with a mortality rate up to 50 percent. Even with optimal treatment, mortality due to severe sepsis or septic shock is approximately 40 percent and can exceed 50 percent in the sickest patients. The Surviving Sepsis Campaign (SCC) partnered with the Institute for Healthcare Improvement (IHI) to incorporate a bundle concept into the diagnosis and treatment of patients with severe sepsis and septic shock. According to the Agency for Healthcare Research and Quality (AHRQ), sepsis is the most expensive cause of hospitalization in the United States, accounting for more than $24 billion annually.

Purpose of the Study/Project: To assist the bedside caregivers with identification of patients in severe sepsis real-time and ensuring initiation and compliance with the sepsis bundle.

Sample Description/Population: The intensive care units of two midwestern area hospitals

Method/Design & Procedure: The interdisciplinary team reviewed the current process of identifying a patient with severe sepsis and initiation and compliance with the septic bundles. A work group was formed to help identify strategies to ensure that all ICU patients were screened real-time for severe sepsis while in the ICU setting. The Virtual ICU offered assistance in screening all ICU patients for severe sepsis. An educational plan was developed which covered criteria to identify those patients with SIRS criteria, sepsis, severe sepsis and septic shock. For the Virtual ICU staff, an I: drive file was created which included research articles, case studies and a workflow so that each patient was screened in the same manner. As the Virtual ICU RN rounds, each patient is evaluated for signs of severe sepsis. If the patient meets severe sepsis criteria, the VICU RN makes contact with the interdisciplinary team member to ensure initiation and/or compliance with the bundle. Reminder calls were made to the bedside prior to the completion of the three hour and six hour bundle to address needs and offer assistance to the bedside. All sepsis occurrences are then tracked on an internal spreadsheet.

Results/Outcomes: Prior to the roll-out of the quality-improvement project on February 1st, 2015, no formal workflow was established to identify a septic patient and follow through with bundle compliance. From February 1st 2015 through October 15th 2015, a total of 1731 patients had ongoing screening for sepsis. Of the 143 patients identified with severe sepsis, 21 of the cases were identified by the VICU RN. The VICU RN initiated contact with the bedside or escalated the positive screen to the eMD.

Conclusions/Implications: The VICU staff has been able to partner with the bedside staff by utilizing real time data with ongoing screenings to ensure the severe sepsis bundle has been initiated and bundle criteria were met. Timelines for initiating and ordering diagnostics, administering appropriate treatments and following up are essential to improving outcomes. Every hour of delay in administering antibiotics increases the risk of mortality by 7 percent. In a multihospital system, it’s difficult to establish a consistent screening process and identify all cases similarly and as early as possible. Our nurse driven screening protocol has assisted the bedside with initiation and bundle compliance. The Surviving Sepsis Campaign states that using “bundles” provides a reliable system in treatment of Sepsis which has been proven to decrease mortality.