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“S” is for Stroke, STEMI, and Sepsis: One Organization’s Process to Treating the Septic Patient

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Friday, April 6, 2018

Scripps Health knew that it was doing well with stroke and ST-Elevation Myocardial Infarction (STEMI), but had an opportunity when it came to treating a septic patient. After a year of using its Value by Design tools at one of its sites, a process was developed for the care of a septic patient. In September 2017, Scripps Health rolled out this process to the rest of the emergency departments (EDs).

At Scripps Memorial La Jolla ED, the team brought a group together including all stakeholders from the ancillary areas, ED physicians, and pharmacy to look at the current process and address any barriers in providing exceptional care to septic patients. They used the system tools and had everyone come up with a process that would expedite care. The ED physicians were key in the process because they order all the tests. The theory was if the ED physicians used the Preformatted Order (PFO) Set—which encompassed all tests, including the fluids, lactate (and repeat lactate), and blood cultures with early administration of antibiotics—Scripps could improve outcomes.

The Scripps team created a systematic process, just as they did with stroke and STEMI, and empowered nurses by giving them the criteria and the opportunity to call a “Code Sepsis” if the triggers were met. The triggers were printed on a badge card so that nurses had easy access to a tool to help them in the decision-making process. When the Code Sepsis is called, all services—lab, radiology, and pharmacy—respond and work together to complete the steps needed to treat that patient in a rapid sequence.

Just as it does with stroke and STEMI, Scripps trained all staff members on the importance of early intervention in the care of septic patients. Staff members were taught that “time is tissue” and, if not treated early, it could lead to organ death and increased mortality. Scripps rewarded staff members and created a “Sepsis Stars” board to recognize those who provided exceptional care to patients and rapid treatment. Scripps used its “Management for Daily Improvement” board to show successes, track the use of the PFO, and identify barriers preventing the team from meeting the goals that were set. Goals included the reduction of opportunities for improvement, and reduction of door-to-antibiotic time for those identified as septic patients. The team continues to meet monthly as a group with its ancillary staff members and present to senior leadership so that all may collaborate together to improve outcomes.

For additional information, please contact Rose Colangelo at 858.349.3551.