NK - New Knowledge, Innovation, and Improvements

NK7EO. Describe and Demonstrate how Translation of New Knowledge in Nursing Practice has Affected Patient Outcomes

Outcomes of Implementing the Surviving Sepsis Campaign at Jersey City Medical Center

Implementation of the Surviving Sepsis Campaign in the Critical Care Division and the Emergency Department is a great exemplar of JCMC’s ongoing improvement efforts through the translation of new knowledge into practice. The adoption of the Surviving Sepsis Campaign Guidelines and the ongoing commitment of the medical and nursing staff, led to significant reductions in mortality rates of patients meeting criteria for severe sepsis and septic shock. Mortality rates dropped from a baseline rate of 48% between January 2008 to June 2009, to 30% in 2010, and 28% in 2011. The momentum of this initiative and the impact of these guidelines continue to sustain as morality rates for 2012 continue to maintain below 28%.

The PI steering committee identified “the Surviving Sepsis Campaign” as a key element in reducing overall mortality. The need to reduce mortality and improve quality of care through the early diagnosis and treatment of patient in severe sepsis and septic shock was recognized. Using the Six Sigma methodology a quality and safety harm event prevention charter was created (Appendix NK7EO-A). Mabel LaForgia MSN, RN, CNL, and Claudia Garzon-Rivera MSN, RN, CNL were appointed to lead the initiative.

Claudia Garzon-Rivera MSN, RN, CNL and Mabel LaForgia MSN, RN, CNL, reviewed mortality data from all patients discharged between January 2008 through June of 2009 with ICD codes of Severe Sepsis and Septic shock. Baseline data revealed an overall mortality rate of 46%.

Discharge Status of Septic Shock Cases, JCMC 2008-2009

With the data at hand, The Clinical Nurse Leaders for critical care reviewed best practices protocols regarding the identification and treatment of patients with severe sepsis and septic shock. The surviving sepsis campaign was an instrumental evidence base resource used by Mabel LaForgia CNL and Claudia-Garzon Rivera CNL to evaluate the gaps that existed in practice. In depth chart reviews of thirty random charts were completed to explore the following:

  • Treatment plan used for severe sepsis and septic
  • Re-evaluated mortality rate to confirm baseline data
    • Confirmed mortality rate: 48%
  • Identify opportunities for improvement in the plan of care and propose evidence based strategies to meet Surviving Sepsis Campaign goals

NK7EO-Table 1

A Collaborative team consisting of representation from the Department of Medicine, Critical Care, Quality Management, Nursing Leadership, Infection control, Pharmacy, Laboratory, Respiratory Therapy, and Emergency Department was formed.

Sepsis Collaborative Team

NK7EO-Table 2

Monthly meetings were organized with the main goal of reducing sepsis mortality by 25% and sustaining it over the next 5 years. Collaborative efforts led to the development of:

Executive Summary: Project Information

After a year of planning, evaluating the literature, and collaborating amongst team members, the evidence based protocols were put in effect in October of 2009. Mabel and Claudia conducted live concurrent reviews during the first year of implementation on all patients meeting criteria for severe sepsis and septic shock. These reviews allowed them to provide real time education regarding the newly established protocols to nursing and medical staff as needed. In addition, all patients that screen positive for severe sepsis and septic shock were entered into the surviving sepsis campaign database for one year (October 2009- September 2010).

Mortality rates and compliance with the resuscitation and management bundles were monitored on a monthly basis. These rates were shared with all members of the interdisciplinary team and with the ED and Critical Care nursing staff during Unit Practice Council meetings. Physician from the ED and Critical Care Units reviewed cases and provide individual feed back to providers of care.

In 2009, JCMC joined New Jersey Hospital Association (NJHA) ICU collaborative on the implementation of the Surviving Sepsis Campaign. In October 2009, Mabel and Claudia had the opportunity to present at the NJHA ICU collaborative learning session regarding the implementation process, barriers encountered, and successes accomplished at JCMC.

To engage leadership and front line staff, several hospital wide educational programs on the recognition and management was implemented during 2010, on all shifts in the ED and critical Care (Appendix NK7E0-G & Appendix NK7EO-H). New knowledge and technologies mentioned in the literature, such as continuous ScV02 monitoring and hemodynamic monitoring via a-line were implemented in order to facilitate accomplishment of resuscitation goals. These efforts gave the nurses and physicians the knowledge and resources needed to successfully lead this improvement effort.

Resuscitation Bundle

Management Bundle

To increase awareness, continue momentum, maintain the translation of new knowledge, the Surviving Sepsis Campaign was discussed with all newly hired physicians and nurses. These efforts were successful in ensuring that all patients in the ED and critical Care were screened and appropriately treated according to the current research findings and evidence based practice.

The ongoing review of the literature and data collected offered opportunities to continuously improve the process. Six months after successful screening and implementation of the surviving sepsis bundles, efforts were joined with the rapid response team. All rapid response calls were to be screened for severe sepsis and Septic Shock. Screening tools and frequently used antibiotics were added to the rapid response box. This ensured that all patients screened positive on the medical surgical floors were treated aggressively and timely.

Severe Sepsis/ Septic Shock Mortality Rates

Severe Sepsis/ Septic Shock Mortality Rates

Severe Sepsis/ Septic Shock Mortality Rates

Severe Sepsis/ Septic Shock Mortality Rates

Engaging leadership and front line nursing and medical staff using literature finding and evidence based practices was the key to success. In 2010, more than one year after implementation, great strides were made in decreasing severe sepsis and septic shock yearly mortality rates from 48% baseline to 30%. This well surpassed the goal of decreasing morality rates by 25%. Almost three years later mortality rates continue to decrease and maintain below 28% year to date. Success is due to continuous collaboration between nursing and the medical staff in translating new knowledge with the goal of positively impacting patient outcomes. Today, improvement efforts by Physicians and Nurses persist as new knowledge in this field continues to grow.