Need for Speed: Collaborative Effort for Early Detection of Septic Patients with Comprehensive Sepsis Criteria Worksheet

Purpose:
Our innovative sepsis criteria worksheet (SCW) care model, began August 2012, drives safety/ quality/service & produces best patient outcomes. It supports Surviving Sepsis Campaign by the IHI. Intention of SCW is to provide series of checks for measurements to be monitored & tasks to be performed.

Significance:
Severe sepsis & septic shock are medical conditions potentially leading to mortality. When series of therapies that make up the sepsis bundle are implemented together, patients have a greater chance for survival. Using the SCW ensures against omission of critical steps in identification & treatment.

Strategy and Implementation:
Our innovative & collaborative checklist was developed by a multidisciplinary team consisting of all levels of nursing from direct care to executive, physicians, quality, respiratory, emergency department (ED), medical ICU (MICU), clinical lab in an effort to quickly identify septic patients & rapidly initiate our “Need for Speed Pathway.” Checklist is easily performed by ED nurse while patient is in triage, MICU nurse on admission, non-ICU nurses. ED & MICU nurses implement worksheet on all patients meeting SIRS criteria. Some SCW components include vitals, labs, lactate level, blood cultures, broad spectrum antibiotic, hemodynamic monitoring/goals, SpO2, CVP/IVC goal, MAP, maintenance criteria. ED/MICU nursing/medical directors review treatment provided to ensure compliance with “Need for Speed” pathway/timeframes; investigate fallouts/pathway non-compliance. Quality outcomes measured. SCW collected/reviewed in MPI meeting, ED/MICU meetings with Medicine Chair, & Medicine PI council.

Evaluation:
Timelier ID of septic patients occurred, causing domino effect to ensue: thorough & proper care via sepsis therapy bundle, leading to better outcomes. Length of stay declined from 10.53 in Q3 to 8.79 in Q4. Mortality rate declined by 21.4% from Q3 to Q4. For sepsis DRGs, 100% received lactate level.

Implications for Practice:
Our comprehensive and innovative SCW can be implemented at any organization through multidisciplinary support. The outcomes monitored will show improvement in patient treatment processes and quality of care.