Say ‘CHEESE’ - Great Plains QIN · 8/15/2018 · SEPTIC SHOCK . Severe Sepsis with persistent...
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8/15/2018 1 1 Say ‘CHEESE’ 2 We are planning to take photos during today’s Learning Session. We plan to use the photos on our website and social media to showcase the great work being done in our state. If you prefer to NOT be photographed, please let a member of our team know.
Transcript of Say ‘CHEESE’ - Great Plains QIN · 8/15/2018 · SEPTIC SHOCK . Severe Sepsis with persistent...
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Say ‘CHEESE’
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We are planning to take photos during today’s Learning Session. We plan to use the photos on our website and social media to showcase the great work being done in our state.
If you prefer to NOT be photographed, please let a member of our team know.
8/15/2018
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|Social Media
http://twitter.com/greatplainsqin
www.facebook.com/GPQIN/
Be part of our conversation|
https://www.linkedin.com/company/gpqin/
https://www.youtube.com/c/Greatplainsqinorg
Great Plains Quality Care Collaborative214 Nebraska Nursing Homes
Committed to Quality Improvement!
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Goals of the National & Great Plains Quality Care Collaborative
Reduce the use of unnecessary antipsychotic medication in dementia residents
Decrease potentially avoidable hospitalizations
Assist nursing homes to attain a National Nursing Home Quality Composite Score of 6.00 or less
Create a culture of resident safety in LTC through: • Uniform methods of communication within nursing homes
• Adoption of antibiotic stewardship principles and practices
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We’re off to see the Wizard…
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Objectives
Discuss the impact MDRO’s, Sepsis and CDI have in our state
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https://greatplainsqin.org/wp-content/uploads/2018/06/NE-Care-Coord-Quarterly-Report.pdf
What is Antibiotic Resistance?
Antibiotic Resistance is the ability of a bacteria to change so that antibiotics can’t kill or stop from reproducing. The bacteria become “resistant” and continue to multiply in the presence of therapeutic levels of an antibiotic.
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A State Look
Antibiotic Prescribed (2015) Antibiotic Stewardship
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https://www.cdc.gov/drugresistance/index.html
MRSA – SERIOUS THREAT LEVEL
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Source: https://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013-508.pdf#page=51
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MRSA
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https://gis.cdc.gov/grasp/PSA/MapView.html
Fluoroquinolone-Resistant MRSA
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https://gis.cdc.gov/grasp/PSA/MapView.html
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CRE – URGENT THREAT LEVEL
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Source: https://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013-508.pdf#page=51
CRE
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CDC – URGENT THREAT LEVEL
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Source: https://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013-508.pdf#page=51
NSHN CDI Project
National Healthcare Safety Network (NHSN)
Nebraska Nursing Homes Participating in NHSN CDI Project
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Assessment – Current CDI Prevention
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SALMONELLA – SERIOUS THREAT LEVEL
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Source: https://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013-508.pdf#page=51
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Statewide Efforts
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https://wwwn.cdc.gov/arinvestments/
Statewide Efforts
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What is Antibiotic Stewardship?
Antibiotic stewardship is the coordinatedeffort that promotes the appropriate use ofantibiotics, improves outcomes, reducesantibiotic resistance and decreases the spreadof infections caused by Multi-Drug ResistantOrganisms (MDROs).
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Unleash the flying monkeys on sepsis…
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Objectives
Define sepsis and the symptoms and conditions in which sepsis should be suspected.
Describe why suspected sepsis is a medical emergency.
Identify sepsis screening tools for long-term care.
Identify discharge education tools and resources related to sepsis.
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Care Coordination Immunizations
Antibiotic Stewardship
Sepsis SIP
HRET HIIN
Nursing Home Care
Sepsis is the #2 reason for admissions and #1 reason for readmissions in the state of Nebraska.
Vaccination Rates: Nebraska Influenza: 57.6% Pneumococcal: 61.7% Madison County Influenza: 56.7% Pneumococcal: 58% Healthy People 2020 goal= 70%
Assisting with implementation of the CDC’s 4 CORE elements of outpatient antibiotic stewardship. 1) Commitment 2) Action for policy
and practice 3) Tracking and
reporting 4) Education and
expertise
1) Assisting with implementation of the CDC’s 7 CORE elements on Antibiotic Stewardship for Nursing Homes
2) Improving Immunization rates
3) Sepsis education around early identification and treatment
4) Infection Prevention
Working toward 20% all harm reduction and 12 % readmission reduction
Focus on early recognition and treatment of sepsis prehospital and in the community.
S E P S
I S
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Sepsis| National Cost
The 20 most expensive conditions, 2013: Rank
Aggregate hospital costs, $ millions
National costs, %
Number of hospital stays, thousands
Hospital stays, %
Treated in U.S. hospitals, all payers
1 23,663 6.2 1,297 3.6
Billed to Medicare 1 14,551 8.2 838 6.0
Billed to Medicaid (Second to live births)
2 3,354 5.3 143 1.9
Billed to private insurance 4 4,028 3.7 218 2.0
For uninsured individuals 1 1,054 5.7 62 3.0
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Source: H-CUP Statistical Brief #204; https://www.hcup-us.ahrq.gov/reports/statbriefs/sb204-Most-Expensive-Hospital-Conditions.jsp
Nebraska Readmissions Hot Spot Map
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30-Day Hospital Readmission Rate perDischarge Location
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https://greatplainsqin.org/wp-content/uploads/2018/06/NE-Care-Coord-Quarterly-Report.pdf
Top Five DRG Bundles for 30-Day Readmissions
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https://greatplainsqin.org/wp-content/uploads/2018/06/NE-Care-Coord-Quarterly-Report.pdf
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Sepsis| Nebraska
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Sepsis Symptoms and Why Sepsis is a Medical Emergency
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Know the Risks. Spot the Signs. Act Fast.
Sepsis is | The body’s extreme response to an infection. It is a life-
threatening medical emergency.
Sepsis happens when| an infection you already have—in your skin,
lungs, urinary tract or somewhere else—triggers a chain reaction throughout your body. Without timely treatment, sepsis can rapidly lead to tissue damage, organ failure and death.
Who is at risk?| Anyone can get an infection and any infection can lead
to sepsis. People at higher risk include: Source: https://www.cdc.gov/sepsis/what-is-sepsis.html
• Adults 65 or older • People with chronic medical conditions, such as
diabetes, lung disease, cancer and kidney disease
• People with weakened immune systems • Children younger than one
Sepsis 911 Video
https://www.youtube.com/watch?v=0KtR93zhkhU#action=share
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Sepsis| A Medical Emergency
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Source: National Sepsis Alliance Fact Sheet; https://d2p9nwuani32ep.cloudfront.net/wp-content/uploads/2016/06/R1-Sepsis-Fact-Sheet-2018.pdf
Sepsis| Harm
Diagnosis | Symptoms may not be recognized
immediately or at all and are often attributed to other
diagnoses contributing to delayed treatment.
Deformity | Everyday, 38 sepsis patients require
amputations.
Death | 270,000 Americans die each year from sepsis.
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Source: National Sepsis Alliance Fact Sheet; https://d2p9nwuani32ep.cloudfront.net/wp-content/uploads/2016/06/R1-Sepsis-Fact-Sheet-2018.pdf
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Sepsis| Awareness
Deficit | Only 40% of U.S.
adults have heard of sepsis
As many as 87% of sepsis cases originate in the community.
Spreading the awareness of the signs and symptoms of sepsis is critical!
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There is no single symptom of sepsis. Symptoms can include a combination of any of the following:
Source: National Sepsis Alliance Fact Sheet; https://d2p9nwuani32ep.cloudfront.net/wp-content/uploads/2016/06/R1-Sepsis-Fact-Sheet-2018.pdf
Source: www.cdc.gov/sepsis and www.sepsis.org
Sepsis Progression
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SIRS Temp >100.4F or
<96.8 F
Resp Rate > 20
Pulse > 90
WBC >12,000 <4,000, 10%
immature bands
SEPSIS
≥ 2 SIRS
+
Suspected or Confirmed Infection
SEVERE SEPSIS
Sepsis +
Organ Dysfunction and/or Failure
Hypoperfusion
SBP< 90 MAP < 65
Altered Mental
Status/Confusion
SEPTIC SHOCK
Severe Sepsis with persistent
hypotension
Signs of End Organ Damage
Long-lasting
effects
Increased mortality rate
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Sepsis Progression
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SIRS Temp >100.4F or <96.8 F
Resp rate > 20
Pulse > 90
WBC >12,000 <4,000, 10% immature bands
SEPSIS
≥ 2 SIRS
+
Suspected or confirmed infection
SEVERE SEPSIS
Sepsis +
Organ dysfunction and/or failure
Hypoperfusion
SBP< 90 MAP < 65
Altered mental
status/confusion
SEPTIC SHOCK
Severe Sepsis with persistent
hypotension
Signs of end organ damage
Long-lasting
effects
Increased Mortality
CMS Sepsis Bundles
3-Hour Sepsis Bundle
Measure Lactate
Obtain blood cultures prior to the administration of antibiotics
Administer broad-spectrum antibiotics
Administer 30ML/KG crystalloid for hypotension or lactate levels > 4MMOL/L
Promote prompt imaging to confirm potential sources of infection
6-Hour Sepsis Bundle
Administer Vasopressors
Reassess volume status and tissue perfusion to ensure adequate resuscitation
Remeasure Lactate
Implement other supportive therapies as indicated by individual patients using algorithms and protocols.
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Health Research & Educational Trust (2017, February). Sepsis and septic shock change package: 2017. Chicago, IL: Health Research & Educational Trust. Accessed at http://www.hret-hiin.org/
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Sepsis Begins in the Community
73 y/o male – not feeling well, colon cancer, dizzy, weak, fever 2 minutes – dispatch receives call and toned out to EMS 5 minutes – EMS volunteers go to station and leave with ambulance 15 minutes – travel to and arrive on scene 15 minutes – assess patient, prepare for transport 20 minutes – leave scene for hospital, call report to hospital 5 minutes - arrive at hospital, transfer care to hospital providers 62 minutes after patient called 911 hospital care begins Physician onsite? Lab/x-ray onsite? Sepsis recognized and bundles started?
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Missed Opportunities
Community Setting • Early recognition of sepsis • Communication of suspected sepsis to physician, EMS
or hospital
EMS • Early recognition of sepsis • Communication of suspected sepsis to tiering ALS
EMS or hospital
Hospital • Early recognition of sepsis • Timely implementation of sepsis bundles
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We suspect SEPSIS
Time is…
In the case of a stroke, time is brain
In the case of heart attack, time is muscle
In cardiac arrest, time is life or death
In trauma…the golden hour
In sepsis, time is organ dysfunction - Carmen Polito, MD
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Polito, C.C. MD. 2016 Southeastern Critical Care Summit. (2016). Prehospital identification and management of sepsis. Available at https://www.youtube.com/watch?v=pk1CNflC-WU
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4 Ways to Get Ahead of Sepsis
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Prevent Infections
• Self-care of Chronic Conditions
• Vaccinations
Good Hygiene
• Hand Washing
• Cover nose/mouth when coughing
• Keep cuts clean and covered
Know the Symptoms • Infection
• Fever/Chills
• Short of breath
• Rapid heart rate
• Confusion
• Pain/Discomfort
• Pale, clammy or sweaty
Act Fast
• Call 911
• Go to ER
• State “I am concerned about sepsis”.
Sepsis Screening Tools for LTC
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GPQIN EMS Sepsis Alert
Sepsis Alert Criteria Initiate Sepsis Alert
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Post-Acute Care Sepsis Early Identification and Treatment Pathway and SBAR for Sepsis
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https://www.tmf.org/Portals/0/Documents/CMP/CMP%20Sepsis%20SBAR_508.pdf
https://www.tmf.org/Portals/0/Documents/CMP/CMP%20Post%20Acute%20Care%20Pathway-FINAL_rd_508.pdf
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Seeing Sepsis Long-Term Care Resources
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https://www.mnhospitals.org/quality-patient-safety/quality-patient-safety-initiatives/sepsis-and-septic-shock#/videos
Sepsis Early Recognition and Management Toolkit
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http://www.mpro.org/sepsistoolkit
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Six Sepsis Presentations
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Screening Tools
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Prevention Tools & Webinars
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Sepsis Coordinator Network
Created by Sepsis Alliance
All health professionals
Collaborative approach
Member tools, resources
Webinars
Forums
https://www.sepsiscoordinatornetwork.org/
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Resident & Family Education Tools and Sepsis Resources
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Sepsis Alliance
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www.sepsis.org
Sepsis 911 Community Education Presentation
Sepsis Alliance
www.sepsis.org
Event checklist
Posters to advertise
PowerPoint presentation
Presentation script
Attendee quiz, survey
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CDC – Get Ahead of Sepsis
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https://www.cdc.gov/sepsis/education/index.html
Resident & Family Education
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https://www.cdc.gov/sepsis/education/index.html
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Resident & Family Education
www.cdc.gov/sepsis www.sepsis.org
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Great Plains QIN
Signs of Infection & Sepsis at Home Stoplight Tool
Sepsis Signs Magnet Sepsis Signs and Symptoms
Poster https://greatplainsqin.org/initiatives/sepsis/
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Resources
http://greatplainsqin.org/initiatives/hac-nh/ http://greatplainsqin.org/initiatives/hac-nh/cdi/ http://qioprogram.org/nursing-home-training-sessions https://www.cdc.gov/longtermcare/prevention/antibioti
c-stewardship.html https://www.cdc.gov/longtermcare/prevention/antibioti
c-stewardship.html https://asap.nebraskamed.com/ https://www.sepsis.org/ https://www.cdc.gov/sepsis/ https://greatplainsqin.org/initiatives/sepsis/
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There’s no place like home…
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Objectives
Identify infection prevention strategies thatpromote a safe environment and quality of lifefor residents with multidrug resistantorganisms and Clostridium difficile in thenursing facility.
Describe the role of standard precautions increating a homelike environment for residentsin the nursing facility.
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Action | Next Steps
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Sharing and Questions
Thank you!!
GreatPlainsQIN.org
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CEs and Evaluation
4.0 Continuing Education Contact Hours awarded by Iowa Western Community College, Iowa Board of Nursing Provider #6
To receive your CE certificate, you MUST sign in todayand complete the evaluation
The evaluation will be sent to attendees after thisevent via email
EVAL/CE DEADLINE:• Gering/Lexington | August 31• Lincoln/Norfolk | September 14
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Contact Information
Tammy Baumann, RN, LSSGB
Krystal Hays, DNP, RN, RAC-CT
1200 Libra Drive, Suite 102
Lincoln, Nebraska 68512
Phone: 402.476.1399 ext. 523 & 522
Fax: 402.476.1335
This material was prepared by the Great Plains Quality Innovation Network, the Medicare Quality Improvement Organization for Kansas, Nebraska, North Dakota and South Dakota, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. 11SOW-GPQIN-NE-C2-216/0818
