Are Your BSI Rates Still A Problem?
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1 Are Your BSI Rates Still A Problem? Rochelle Whitmore, MSN RN CRRN Achieving Results Through Nursing Innovation March 5, 2019
2 Everett Kircher Dialysis Center
3 Objectives By the end of this session, the learner should be able to: Describe one innovative practice that could help lower BSI rate. List the low, moderate, and high-risk signs and symptoms of sepsis and the recommended actions to take at each level. Describe the potential benefits of using the Outpatient Dialysis Early Warning Screen (ODEWS).
4 Background Performance Improvement Project: May BSI rates were unfavorable RCA on each case Numerous BSIs resulted from other conditions that have nothing to do with the dialysis access (ie; pneumonia, urosepsis, wound infections, spinal abscesses, etc )
5 Step 1: Follow the Recommendations 9-Core Interventions Surveillance Audits Staff & patient education Catheter reduction, etc
6
7 Station Disinfection
8 Innovation: Explore Sepsis Create an assessment tool for early identification with recommendations for taking quick action MEOW (Modified Early Warning Score Criteria and Response) SOFA ( Sepsis Organ Function Assessment) qsofa (Quick Sepsis Organ Function Assessment) SIRS criteria (Systemic Inflammatory Response Syndrome) Most tools do not address the ambulatory setting where early identification of symptoms is critical in this vulnerable patient population.
9 SIRS Systemic Inflammatory Response Syndrome MEOW Modified Early Warning Score Criteria Create the ODEWSS Tool SOFA Sepsis Organ Function Assessment qsofa Quick Organ Function Assessment
10 Available via
11 Subjective Symptoms-Patient Reported Signs & Symptoms Infection? *check Y or N Yes No cough wound-drainage, warmth, redness sore throat pain, frequency, or urgency urinating diarrhea Fever Fever / chills or feeling chilled HR feels like it's racing RR feel short of breath-fast breathing LOC confused, excessive sleeping, exhausted Pain Extreme pain Skin Pale or discolored skin
12 68 y/o male with coughing, lethargy, and chills, and confused. TPR= /88 Score Range Clinical Response Green Zone 0-1 No action required Yellow Zone 2-3 Contact PCP-alert to signs/symptoms observed. RED Zone 3 and > Schedule same day appointment w/pcp if able OR recommend ED for evaluation
13 The Data Doesn t Lie NHSN Standardized Infection Ratio (SIR) for Dialysis Event Blood Stream Infections 2.5 SIR Implementation May
14 Unexpected Surprise The goal was always to reduce BSI rate Assumed a reduction in BSIs, severe sepsis and septic shock because of the focus on early identification. Data demonstrates an overall reduction in the number of patients hospitalized, and sepsis cases overall.
15 Patient s Hospitalized With Infection Patient's Hospitalized With Infections Intervention May
16 Raw Numbers Simple Sepsis : Dialysis Patients 3.5 Sepsis cases cases cases
17 Raw Numbers Severe Sepsis : Dialysis Patients 2.5 Severe Sepsis cases cases cases
18 Raw Numbers Septic Shock : Dialysis Patients 3.5 Septic Shock cases cases cases
19 Low-Moderate- & High Risk Symptoms & What to do
20 Benefits of Using the ODEWSS Tool Reduced SIR significantly Data doesn t lie Reduced the number of patients hospitalized with infections Reduced the number of patients hospitalized with sepsis, severe sepsis, and septic shock Nurses came up with an idea that saved lives and reduced costs! CMS 5-Star Facility Rating
21 2018 ANNA National Symposium Las Vegas, NV
22
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