Simplifying Sepsis in the

Emergency Department
Joseph Ochoa, Isaac Deleon-Daniels, Bella Heines, Milla Vasquez, & Samantha Kennepohl
Professor Sarah Hoogasian & Professor Mary O’Connell
November 28, 2023
 Table of Contents

01 02 03
Project Team & Quality Model for
Unit Introduction Improvement Issue Improvement

04 05 06
Potential Barriers Visual Aid References
01

Introduction
Project Team: “King Cup”

● Joseph Ochoa

● Isaac Deleon-Daniels

● Bella Heines

● Milla Vasquez

● Samantha Kennepohl
 Unit Introduction
● St. Joseph's Hospital in Tucson, AZ
○ Level 1 Trauma Center, Comprehensive Stroke Center
● Emergency Department
○ Patient Population:
■ Ages 18+
■ Non-life threatening to life threatening injuries
■ Yearly census 110,000, daily census ~300
○ Staffing:
■ ~ 1:4 nurse/patient ratio
■ Emergency Physicians, Emergency Medical Technicians, Paramedics, Trauma
Nurses, Charge Nurses, Behavioral Health Technicians, Emergency Department
Nurses, Nurse Practitioners, Patient Care Technicians, Triage Administrative
Staff
○ Leadership Team Structure:
■ Team nursing
 02. Quality Improvement Issue
SEPSIS POWER PLAN USE AND TOTAL COMPLIANCE:

● Sepsis and septic shock present in more than 50% of adult

hospitalizations ending in death or terminal discharge to a hospice.
(Choi et al., 2021)

● CSJ Sepsis Core Measure to track % of compliance

(all or none)
■ Goal ≥ 70%
● Audits of patients who met criteria for severe sepsis
Current Actions or septic shock
● Nursing Intervention Bundle education
● Sepsis Awareness month & incentives
● Provider Action
■ “Code Sepsis
■ Standing orders for early ambulation
● DECEMBER 2021: 8% compliance → JUNE 2023: 89%
03. Model for Improvement:
Forming the Team
Nurse Educator Providers
Essential for disseminating Must be educated on, and agree to
information to RNs and answering order sepsis bundle for patients
questions when they arise

House Supervisor RNs

Responsible for tracking data on Need to be educated on sepsis bundle so
success of education and examining they can quickly implement interventions
cost of implementation and anticipate actions regarding later
stages
 Model for Improvement: Setting
Aims
Our Aim: Increase total sepsis bundle
compliance in the emergency
department to at least 90% within 6
months of staff education
implementation.
Model for Improvement: Establishing Measures
● Total Percent Compliance of Sepsis Bundle
■ % of cases that met all criteria implementing sepsis bundle
● Outcome Measure Goal
■ Greater than or equal to 70% all or none compliance, with limited month to
month variability
● Current Unit Data
■ December 2021: 8% compliance
■ December 2022: 54% compliance
■ Last 6 Months (May 2023): 62% compliance
■ June 2023: 89% compliance
● National Benchmark
■ Among hospitals reporting SEP-1 data, SEP-1 performance was highly
variable, with a mean of 48.9 ± 19.4 % bundle compliance and a range from
0 to 100% (Barbash et al., 2019)
Model for Improvement: Selecting
Changes

Improved Staffing Reducing Workload Improved Training

Improving overall staffing Improves ability of nurses Improves recognition of
of doctors and nurses to to complete sepsis Sepsis and implementation
reduce delays in care. bundles for individual of Sepsis care bundles.
patients by allocating
more time to fewer
patients.

(Lynn et al., 2018)

(Edwards & Jones, 2021)
 Model for Improvement: Testing Changes
PLAN
● Objective: Test sepsis bundle knowledge
using teach-back on a small group of
shift RNs to improve understanding of
how to implement the bundle, increase
early identification, and improve
provider notification for “code sepsis”.
● Questions/Predictions:
- How to make information efficient and
easily accessible.
- Nurse hesitancy to leave the unit for
education and incorporation with
other education needing to be
completed
- Incentives for completion of bundle
education and successful teach back.
● 4 Ws: Use nurse/unit managers to
coordinate with educators to develop
time frames for shift nurses to leave the
unit and participate in education in a
smaller, dedicated group setting.
● Upon completion of training nurses with
sign off on status and after a week
waiting period, randomly selected nurses
who completed the training will
complete a quiz and be assessed on
teach back by educators.
● Compliance audits will continue to be
conducted monthly and education will be
provided quarterly until stable
compliance percentage.
 Model for Improvement: Testing Changes
PLAN
DO ACT
● Implementation: ● Determine fluctuations
- Education provided in in compliance following
classroom setting during a STUDY 6 month
nurse scheduled hour education/assessment
period. ● Evaluate competency 1 periods.
- Assessment of knowledge week post and every 6 ● Consider training
to occur 1 week following months. periods; if >90%
completion of training. ● Continue monthly consistent training bi-
- Reeducation every 6 audits to assess annual or yearly, if
months. compliance trends. variation consider
quarterly
education/assessment.
 Timeline

Staff scheduling to allocate

December 2023 Implementation of bi- Focused review of
resources and offer
YTD Compliance % annual education on compliance % prior to
different education session
sepsis bundle re-education
times.

6-month Education and Focused review of Follow-up assessment December 2024

Assessment compliance % the for outcomes YTD Compliance %
month following
 04. Potential Barriers

● Hesitancy to leave unit

○ Knowledge of proper delegation.
○ Incentive: point-system (ex. Peter
Piper’s )
● Time management
○ Adequate staffing.
○ Incentive: free hospital merch!
 05. Visual Aid - Simplifying Sepsis
Project Overview

1 2 4
3

OBJECTIVE: Increase total sepsis bundle compliance in the emergency department

to at least 90% within 6 months of staff education implementation.
Thank You!
Do you have any questions?

CREDITS: This presentation template was created by Slidesgo, and

includes icons by Flaticon and infographics & images by Freepik
 06. References

Choi, S., Son, J., Oh, D. K., Huh, J. W., Lim, C. M., & Hong, S. B. (2021). Rapid response system improves sepsis bundle
compliances and survival in hospital wards for 10 Years. Journal of Clinical Medicine, 10(18), 4244.
https://doi.org/10.3390/jcm10184244

Edwards, E., & Jones, L. (2021). Sepsis knowledge, skills and attitudes among ward-based nurses. British Journal of
Nursing, 30(15), 920–927. https://doi.org/10.12968/bjon.2021.30.15.920

Lynn, N. B., Gupta, C., Vaaler, M., Held, J., Leon, L., (2018). Severe sepsis 3-hour bundle compliance and mortality.
American Journal of Infection Control, 46(11), 1299-1300. https://doi.org/10.1016/j.ajic.2018.04.228

Milano, P. K., Desai, S. A., Eiting, E. A., Hofmann, E. F., Lam, C. N., & Menchine, M. (2018). Sepsis bundle adherence is
associated with improved survival in severe sepsis or septic shock. The Western Journal of Emergency Medicine,
19(5), 774–781. https://doi.org/10.5811/westjem.2018.7.37651