Sepsis Improvement Project“Sepsis Kills”

Wirral University Teaching Hospital NHS FT

Team DetailsNames Roles

Contact Details

Mark Hughes Sepsis Lead, ICM ConsultantMhughes5@nhs.net

Louise Taylor AQ/Compliance Manager, Q&S

Jane Langley Clinical Audit Lead, Q&S

Leeanne Lockley AQ Case Manager, Acute Care

Tori Young Lead Antimicrobial Pharmacist

John Cunniffe Infection Control Lead, Med Micro Consultant

Andrea Wootten Consultant in Emergency Medicine

Helen Morris ED Senior Sister

(Helen Kielty Clinical Coding Manager)

(Conor Mcgrath ICM Consultant)

What was your original project Aim and has this changed?

Original AIM: To improve the awareness, recognition and timely management of Sepsis. Increase use of WUTH Sepsis pathway.

Details of changes: The original aim focused more on pathway use as a means to achieve improved recognition and care. We have actually driven all components above.

Explanation of changes: Difficult to collect all measures (particularly accurate Pathway use) due to manpower shortages. We have had to focus on key measures (required by AQ) therefore. In process of converting paper Sepsis pathway to electronic version.

DRIVER DIAGRAM

Driver diagram

Please insert your driver diagram

5

Measures and Data• Measures:

• Dara challenges

AQ measures

• Patients with community sepsis (70%)• Performance within 3 hours of hospital

arrival• May not be recognised within first 3

hours!• Includes:

1. EWS <60 mins of hospital arrival

2. Evidence of sepsis (and documentation of suspected source) within 2 hours of arrival

3. BC taken < 3h of hospital arrival

4. Abs given <3h of arrival

5. Lactate measured <3h

6. Senior review <4h of arrival

Our measures

• All patients with suspected or confirmed sepsis

• Performance within 1 hour from recognition of sepsis

• Includes:1. Sepsis recorded in case notes:

2. Severity of sepsis recorded?

3. Use of pathway:• Used at all?• Used correctly?

4. Blood cultures within 1 hour of recognition of possible sepsis?

5. Antibiotics within 1 hour of recognition

6. Serum lactate measured within 1 hour

Data: Improved recognition & Coding

Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-150

20

40

60

80

100

120

140

160

180

200

AQ population

AQ population

Performance Data

Sep-14 Oct-14 Nov-14Dec-14 Jan-15 Feb-15 Mar-15 Apr-15May-15Jun-15 Jul-1530.00%

40.00%

50.00%

60.00%

70.00%

80.00%

90.00%

Antibiotics administered within 3 hours of hospital arrival

Antibiotics administered within 3 hours of hospital arrival

Baseline

Performance Data:

0%10%20%30%40%50%60%70%80%90%

Blood Cultures taken <3 hours of Hospital arrival

Blood Cultures taken <3 hours of Hospital arrival

0.00%

20.00%

40.00%

60.00%

80.00%

Serum lactate measured < 3 hours of hospital arrival in

suspected sepsisSerum lactate measured < 3 hours of hospital arrival in sus-pected sepsis

Key Achievements & Lessons Learnt• What have we learned

– Targeted teaching and promotions achieves better buy in– Temperatures checks are very useful tools– Not easy driving improvement changes

• As soon as we relax, performance dips!!

• What has worked well and why– The team: highly motivated and functional group– “Sepsis September” (& equivalent) campaigns

• Month long education & awareness drives• Providing support and materials, but encouraging clinical leads in the targeted area to decide best way to deliver• No prescribed formulae for these!

• What would you do differently– Look to get full time team members in much earlier

• Still not achieved this, but on executive agenda (Full time Sepsis nurses)

Key Achievements & Lessons Learnt

• What impact have you made– Raised Sepsis profile within Trust– Improved recognition & clinical coding– Improved antibiotic delivery times in community Sepsis (AQ population)– Making a difference (but slowly!)

• What are you most proud of– Team effort & performance:

• Functional, committed group• Very effective operationally

– Early days yet, but implementing an electronic (IT) Sepsis ALERT

What should AQuA do differently

• More time for team work

• Excellent facilitator support – continue to encourage