VA Palo Alto Healthcare System EvidenceBased Practice Sepsis

VA Palo Alto Healthcare System Evidence-Based Practice Sepsis Initiative

VA Palo Alto Healthcare System Evidence-Based Practice Sepsis Initiative Team O Kristina Castro, MSN, RN, CNL O Kristen Valente, BSN, RN-BC, ONC O Desiree Picazo, BSN, RN, CRRN O Leisa Ann Bunte, BSN, RN, CEN, CCRN, CFRN O Denise Renfro, MS, RN

Livermore Division

Background O Mortality rate at the VA was very sporadic as high as 18% O Veterans are a very high-risk population due to age and multiple co-morbidities O Increased length of stay O Often leads to additional complications

Baseline Sepsis Mortality

The Process Practice Question Evidence Translatio n

Stakeholders O Medicine Service O Surgical Service O Pharmacy O Infectious disease O Critical care O Emergency department O Nursing Service O Leadership support

The Process

Sepsis Simulation Bus

Sepsis Simulation Bus O First VA in the nation to host the sepsis training center O Staff nurses from all inpatient areas were able to attend O MDs and Respiratory Therapists also participated to ensure a multidisciplinary approach to sepsis

Translation O Educated all staff during 3 consecutive days O Implemented screening tool in the ER and Medicine floor initially, then to the Surgical floor O Evaluated outcomes and reported to the stakeholders

Results

Challenges O Developing team collaboration O Protected time O EBP member turn over O MD education O RN to MD SBAR

Lessons Learned O This is an ongoing and continuing process O Big investment: time and effort O Need to provide concurrent and retrospective feedback to staff at the bedside

Next Steps O Transition from paper documentation to computerized documentation O Implement on 2 C, ICUs, and rehabilitation (hospital-wide)

Continued Learning O The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). O Response from Surviving Sepsis Campaign.

Conclusion O Positive impact on large number of nurses and patients

References O Dellinger et al. Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock. Critical Care Med 2013; 41: 580637

Questions