Sepsis Core Quality Measures Webinar
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1) The document discusses CMS's new sepsis core measures that took effect in October 2015 and are aimed at improving early management of sepsis through compliance with sepsis bundles. 2) It provides an overview of the definitions for severe sepsis and septic shock that determine when the core measure time clocks begin. The measures require drawing lactate and blood cultures, administering antibiotics and fluids, and reassessing patients within 3 and 6 hours of presentation. 3) Successful implementation of the sepsis core measures requires standardized identification processes, evidence-based treatment adhering to bundles, and ongoing process improvements including engaging physicians, identifying gaps, and facilitating a culture of protocol compliance.
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Sepsis Core Quality Measures Webinar
- 1. CMS Core Measures Essentials All You Need to Know About Sepsis Core Quality Measures Jan 29, 2016 / 10:00 am PST – 10:30 am PST Sponsored by AcesoCloud http://www.acesocloud.com
- 2. Introducing our Speaker Dr. Andre Vovan Chief of Service, Critical Care 15 years as Intensivist 11 years experience running sepsis program Participated in Original Surviving Sepsis Campaign Decreased mortality >50% Decreased cost/case of sepsis >50 2January 2016 AcesoCloud Webinar
- 3. Background
- 4. Sepsis Core Measures January 2016 AcesoCloud Webinar 4
- 5. Sepsis Core Measures & Sepsis Bundles
- 6. All about Sepsis Core Measures January 2016 AcesoCloud Webinar 6 Effective October 1, 2015 discharges Focused on patients diagnosed with severe sepsis or septic shock Emphasis on early management of Sepsis Consistent with the Surviving Sepsis Campaign guidelines Objective is to lower rates of organ failure, mortality, length of stay, and cost of care Comprises comprehensive two all or none bundles
- 7. SEP-1 Definitions January 2016 AcesoCloud Webinar 7 Severe Sepsis o suspected source of infection o 2 SIRS criteria, and o evidence of end-organ dysfunction Septic Shock o initial lactate greater than or equal to 4 mmol/L o Evidence of hypotension in the first hour following completion of a 30 cc/kg IVF bolus
- 8. January 2016 AcesoCloud Webinar 8
- 9. How is the new Core Measures different January 2016 AcesoCloud Webinar 9 Compared to previous core measures SEP-1 is… o more complicated o requires more teamwork, and o has the potential to more significantly impact patient outcomes in terms of mortality, morbidity, and hospital length-of-stay Time of presentation o Unlike most other core measures in which the clock starts upon admission, for this measure, the clock starts when the patient meets criteria for either severe sepsis or septic shock Chances are your hospital quality team is still developing a sound understanding of the core measures!
- 10. Key Abstractions January 2016 AcesoCloud Webinar 10 The course of treatment is dependent on Time of Presentation (TOP) documented by the nurse/Physician Care protocol implementation is based on the two clocks: o Three hour o Six hour Clock starts when Severe Sepsis presentation is documented, either by diagnosis or criteria: o For ED patients the clock begins when the patient is diagnosed with Severe Sepsis o If Sepsis occurs later, the earliest time all symptoms present or diagnosis documented is the time when the clock begins.
- 11. 3 Hour Sepsis Bundles January 2016 AcesoCloud Webinar 11 Within 3 hours from TOP o draw a lactate, o draw blood cultures prior to administration of antibiotics, and start broad-spectrum antibiotics or approved combination of antibiotics o Administer 30ml/kg crystalloid for hypotension or lactate ≥4mmol/L
- 12. 6 Hour Sepsis Bundles January 2016 AcesoCloud Webinar 12 Within 6 hours from TOP, initiate all the above plus: o IVF bolus of 0.9% NS or LR 30ml/kg o If hypotension persists within 1 hour of completion of initial fluid resuscitation, administer vasopressors to maintain a mean arterial pressure (MAP) ≥65mmHg o If hypotension persists after initial fluid administration (MAP < 65 mm Hg) or if initial lactate was ≥4 mmol/L, re-assess volume status and tissue perfusion and document findings. o Re-measure lactate if initial lactate elevated > 2mmol/L or hypotension
- 13. Table 1 January 2016 AcesoCloud Webinar 13 Document reassessment of volume status and tissue perfusion with Either Repeat focused exam (after initial fluid resuscitation) including vital signs, cardiopulmonary, capillary refill, pulse, and skin findings. Or Any two of the following measures: o Measure CVP o Measure ScvO2 o Bedside cardiovascular ultrasound o Dynamic assessment of fluid responsiveness with passive leg raise or fluid challenge
- 14. Sepsis Bundle Implementation - Process Map
- 15. January 2016 AcesoCloud Webinar 15 Time of Presentation Screening & Documentation Initiate Sever Sepsis and/or Septic Shock Bundle Initial Lactate Level Draw Blood Cultures Complete within 1Hr max 3 Hrs 3+ Hrs Administer broad- spectrum antibiotics If <90 or >40below baseline or MAP <65 Or initial lactate level >36mg/dL Total bolus of min 30mL/kg IVF bolus of 0.9% NS or LR 30ml/kg Complete within 6Hr max If initial lactate >2mmol/L Repeat serum lactate level If SBP<90 or MBP<65 within 1 hour of completing 30ml/kg fluid bolus If MBP>65 STOP If lactate is >4mmol/L, perform repeat volume and tissue perfusion assessment If hypotensive patient is unresponsive to fluid bolus of 30mg/dL initiate vasopressors Repeat volume and tissue perfusion assessment including: • Vital signs • Cardiopulmonary exam • Capillary refill evaluation • Peripheral pulse evaluation • Skin evaluation OR Any two of the following: • Central venous pressure measurement • Central venous oxygen measurement • Cardiovascular ultrasound • Dynamic assessment of fluid responsiveness with passive leg raise or fluid challenge Patient meets criteria for Severe Sepsis and/or Septic Shock
- 16. Sepsis Core Measures Exclusions January 2016 AcesoCloud Webinar 16 The patient is excluded if … o “comfort care” is ordered for the patient within 3 hours of time of presentation of severe sepsis and 6 hours of septic shock o Patient expires within 3 hours of severe sepsis or 6 hours of septic shock o Patient is transferred from outside hospitals and emergency departments o Patient/decision maker refuse any component of the recommended care
- 18. Key Components January 2016 AcesoCloud Webinar 18 Standardized Identification o Automated screening tools and alert systems o Definite sepsis processes with clearly laid role definitions Evidence Based Treatment o Physician engagement and accountability o Train and empower nurses to use sepsis bundles Process Improvements o Identify champions to evaluate sepsis programs o Facilitate, measure and reward physician engagement o Engage frontline clinicians to identify process gaps o Execute, monitor and measure process improvements o Facilitate shift in culture towards protocol compliance
- 19. Jan 2016 AcesoCloud Webinar 19 Why so few health systems truly manage quality Physician empowerment & engagement Appropriate analytics & technology solutions Shifting priorities of governance & leadership Organizational culture & ability Executive engagement & awareness Multiple contrasting priorities
- 20. 20 Four-Tier QI Plan for Sepsis Program ANALYZEANALYZE PLAN PTIMIZE Jan 2016 AcesoCloud Webinar
- 21. Jan 2016 AcesoCloud Webinar 21
- 22. Jan 2016 AcesoCloud Webinar 22 Thank you for joining us! If you would like to obtain additional information or are interested in discussing how AcesoCloud can help please feel free to contact us. Contact Email: info@acesocloud.com About AcesoCloud: http://www.acesocloud.com
- 23. February 17, 2016 23