Improving Severe Sepsis/Septic Shock Screening and Accuracy
Susan Abrams RN-BC, BA Carson Del Greco Julie Gaspar RN, PCCN Danielle Park RN, BSN, CCRN Summer Gupta
RN, MSN Lisa Harrison RN, BSN Mary Lawanson-Nichols RN, MSN, NP, CNS, CCRN Trudy Rhodes RN Mackenzie
Roesti RN MSN, CCRN Patty Sheehan MN, CNS, RN, CCRN-K Kimberly Ternavan RN, MS/MBA, NE-BC
UCLA Health, Ronald Reagan Medical Center/Santa Monica Hospital
Currently, 33% of Santa Monica Hospital (SMH)
patients have a nurse sepsis screen completed
within one hour after time of presentation
(TOP) with 38% accuracy. At Ronald Reagan
Medical Center (RRMC), only 39% of patients
are screened within one hour after TOP with
44% accuracy. These deficiencies cause delayed
implementation of the sepsis treatment
bundle and can be linked to increased
mortality, length of stay, and cost.
Current State
- CMS reviewed charts with TOP in the
inpatient areas between March Dec 2016
- Reviewed for accurate and complete
screening within one hour after TOP
- Sepsis Nurse Roles/Responsibilities (SMH)
Started December 2017
Identifies pts with elevated MEWS
and reviews charts for possible
Severe Sepsis/Septic Shock
Visits primary RN to discuss pt
status, screening, and plan of care
- RRMC did not have a role dedicated to sepsis
surveillance; however they have a clinical
surveillance team that monitors clinical
deterioration using the MEWS tool.
Objectives
50% screening within one hour of TOP with
50% accuracy by June 30, 2017
62% screening within one hour of TOP with
62% accuracy by Dec 31, 2017
75% screening within one hour of TOP with
75% accuracy by March 31, 2018
Results
Solutions
Problem Statement
Root Cause
Tested Solution
Responsible
Go-Live/
Completion
Accuracy and Timeliness:
RRMC
Q1/Q2
2017
Q3/Q4
2017
Q1 2018
Organ dysfunction of previous shift is
unknown
Modify screening tool to allow RN
to choose organ dysfunction
IT workgroup
04/05/2017
Organ dysfunction is not recognized
Modified screening tool that autopopulates vital signs and lab values
IT workgroup
11/15/2017
Timeliness
1 /10 = 10%
1 /9 = 11% 1 /4 = 25%
Insufficient report r/t increased RN
accountability
Dual nurse screening at handoff
All / RN
Champions
11/15/2017
Accuracy
0 /1 = 0%
0 /1 = 0%
Unable to dive deep in chart r/t
increased pt acuity
Dual nurse screening at handoff
All / RN
Champions
11/15/2017
RN does not recognize urgency to rescreen r/t misunderstanding of patho
and mortality data
Education Use of MEWS scores
to prompt re-screening of pt.
(5MN and 7W)
Julie, Patty,
Mackenzie,
Susan
08/31/2017
SIRS and organ dysfunction attributed
to causes other than infection r/t RN
concern of provider pushback
Deferred
Deferred
Deferred
Misconceived perception of
seriousness of organ dysfunction
Education Use of MEWS scores
to prompt re-screening of pt.
(5MN and 7W)
Julie, Patty,
Mackenzie,
Susan
08/31/2017
Sepsis Dynamic Nurse Screening Tool
SM
Q1/Q2
2017
0 /1 = 0%
Q3/Q4 Q1 2018
2017
Timeliness
11 /19 = 58% 6/11 = 55% 1/ 3 = 33%
Accuracy
5 /11 = 45%
5 /6 = 83% 1 /1 = 100%
Mortality Index:
Severe Sepsis/Septic Shock Not
Present on Admission (POA)
10/2015 03/2018
RRMC and SMH
Next Steps
Due to our interventions, nurse screening
accuracy and timeliness have improved at
SMH, but we have not seen this improvement
at RRMC. Overall, we have seen a reduction in
the mortality index with severe sepsis/septic
shock not POA. We continue to create
educational opportunities for nurses by
holding four hour mandatory education
classes related to the role of nurses and sepsis
care. Completion will occur by March 2019.
We will continue to monitor/evaluate
timeliness and accuracy. In addition, our
workgroup continues to modify and improve
the dynamic screening tool to make it user
friendly and clear for all nurses.
