SEPSIS: GETTING STARTED

Transcription

1 SEPSIS: GETTING STARTED Ohio Sepsis Initiative July 15, 2015

2 SEPSIS INCIDENCE Definition: the number of severe sepsis or septic shock encounters using the following ICD-9 codes ( Sepsis, severe sepsis, septic shock) per month Numerator: the number of patients admitted to the acute care setting with severe sepsis or septic shock Denominator: Total number of inpatient encounters July 15,

3 Severe Sepsis & Septic Shock Incidence and Mortality, 2012Q1-2014Q3 Encounters Incidence Deaths 4000 Mortality Sepsis POA Sepsis Not POA Sepsis POA Sepsis Not POA July 24,

4 SEPSIS MORTALITY Definition: Percent of patients with severe sepsis or septic shock using the following ICD-9 codes ( Sepsis, severe sepsis, septic shock) who expire during a hospital admission Numerator: the number of patients admitted to the acute care setting with severe sepsis or septic shock who died (discharge code of 20) during the hospital stay. Denominator: the number of patients admitted to the acute care setting with severe sepsis or septic shock July 15,

5 Rate (%) 35 SEVERE SEPSIS & SEPTIC SHOCK MORTALITY, 2013Q4-2014Q Lower is better, 15.5 is the statewide mean 10 Statewide improvement target is hospitals (4 OHA Sepsis Initiative) have a rate of 0 OHA Sepsis Initiative Hospitals Other Ohio/OHA Member Hospitals July 15,

6 Rate (%) 60 SEVERE SEPSIS & SEPTIC SHOCK NOT POA MORTALITY, 2013Q4-2014Q Lower is better, is the statewide mean 30 Statewide improvement target is hospitals (3 OHA Sepsis Initiative) have a rate of 0 OHA Sepsis Initiative Hospitals Other Ohio/OHA Member Hospitals NOTE: Eleven hospitals participating in the OHA Sespsis Initiative did not have sepsis not POA encounters for the period 2013Q4-2014Q3. July 15,

7 Rate (%) 35 SEVERE SEPSIS & SEPTIC SHOCK MORTALITY, 2013Q4-2014Q Beds Lower is better, 15.5 is the statewide mean 10 Statewide improvement target is hospitals (4 OHA Sepsis Initiative) have a rate of 0 OHA Sepsis Initiative Hospitals Other Ohio/OHA Member Hospitals July 15,

8 Rate (%) 35 SEVERE SEPSIS & SEPTIC SHOCK MORTALITY, 2013Q4-2014Q Beds Lower is better, 15.5 is the statewide mean Statewide improvement target is hospitals have a rate of OHA Sepsis Initiative Hospitals Other Ohio/OHA Member Hospitals July 15,

9 Rate (%) 35 SEVERE SEPSIS & SEPTIC SHOCK MORTALITY, 2013Q4-2014Q Beds Lower is better, 15.5 is the statewide mean Statewide improvement target is OHA Sepsis Initiative Hospitals Other Ohio/OHA Member Hospitals July

10 PROCESS MEASURES July 15,

11 SAMPLE SIZE Prefer a minimum of 10 discharge charts per month but more would be desirable. You can use sepsis charts used for core measure submission or any charts from other populations. Excluded populations are patients with Palliative care order prior to 180 minutes from arrival. July 15,

12 CMS SEPSIS ALGORITHM July 15,

13 INITIAL LACTATE LEVEL (Yes) An initial lactate level was drawn in the time window between 6 hours prior to and 3 hours following the presentation of severe sepsis. July 15,

14 Yes for initial Lactate level July 15,

15 BLOOD CULTURE COLLECTION Allowable Values: 1 (Yes) A blood culture was drawn in the time window between 48 hours prior to and 3 hours following the presentation of severe sepsis July 15,

16 Yes for Blood Culture July 15,

17 ANTIBIOTIC ADMINISTRATION Allowable Values: (Yes) A broad spectrum or other antibiotic was administered intravenously in the time window 24 hours prior to and 3 hours following the presentation of severe sepsis. An antibiotic listed on CMS Data dictionary Table 5.0, 5.1, or in data element Broad Spectrum or Other Antibiotic Selection July 15,

18 Yes for Antibiotic Administration July 15,

19 CRYSTALLOID FLUID Allowable Values: ADMINISTRATION (Yes) Crystalloid fluids were administered after the presentation of septic shock, or crystalloid fluids were being administered at the time of presentation of septic shock AND the volume ordered was 30 ml/kg. ONLY 0.9% Normal Saline or Lactated Ringers Solution. July 15,

20 Yes for crystalloid fluids July 15,

21 DATA ENTRY July 15,

22 LOG-IN July 15,

23 DATA ENTRY OHA will upload mortality data Hospitals enter data Be sure to save data before leaving page

24 DATA REPORTS Select measure Select Timeframe Click view to see results

25 DATA REPORTS July 15,

26 EARLY GAP SURVEY RESULTS July 15,

27 EARLY GAP ANALYSIS RESULTS Have Sepsis Screening Tool Screening Location Have Sepsis Screening Tool 0 ED M/S Unit ICU Other Yes No Yes No July 15,

28 EARLY GAP ANALYSIS RESULTS Screening Frequency Alert Mechanism in Place Triage Q shift Inpatient Yes No Yes No July 15,

29 EARLY GAP ANALYSIS RESULTS Have Sepsis Order Set/Protocol Hour Bundle Lactate Level Bld Culture Antibiotic Fluids Yes No Yes No July 15,

30 EARLY GAP ANALYSIS RESULTS Antibiotic Dispensing System W/I 1 hour Time Zero Method for Visual Cue ED Inpatient Yes No Yes No July 15,

31 EARLY GAP ANALYSIS RESULTS Track Clinician Adherence Meetings for Sepsis Review Yes No Yes Partly No July 15,

32 HOW TO PRIORITIZE EFFORTS To Do over next month Complete Gap Analysis Identify areas where you differ from recommended Form an interdisciplinary team to address Sepsis Identify executive champion Identify clinical champion Set Aims (be specific) July 15,

33 HOW TO PRIORITIZE EFFORTS To do over next month Develop an action plan Align with organization goals Determine target vs. broad approach Look for and focus on low hanging fruit Implement action plan Collect and submit data monthly Do small tests of change July 15,

34 NEXT MONTH August 12 Three Hour Bundle James O Brien, MD, MS Vice President, Quality & Patient Safety OhioHealth Riverside Methodist Hospital Data due Aug 15 July 15,

35 OHA collaborates with member hospitals and health systems to ensure a healthy Ohio James V. Guliano, MSN, RN-BC Vice President, Quality Programs james.guliano@ohiohospitals.org Rosalie Weakland, MSN, RN, CPHQ, FACHE Senior Director, Quality Programs rosalie.weakland@ohiohospitals.org Ryan Everett Director, Population Health Ryan.Everett@ohiohospitals.org Ellen Hughes, RN Quality Coordinator Ellen.hughes@ohiohospitals.org Ohio Hospital Association 155 E. Broad St., Suite 301 Columbus, OH T ohiohospitals.org