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Take the Shock Out of Sepsis

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Why Use Simulation?

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Simulation in Aviation

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Miracle on the Hudson

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© Medical Simulation Corporation 2009

A Changing Landscape

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On-Line Course

Didactic Review

Simulation

Debrief

Blended Learning

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Understanding the Guidelines

Standardized Metrics Individualized Feedback

Putting the Guidelines into Practice

The Application of Simulation

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MSC QI Program Components

Pre and Post course knowledge assessment & confidence survey

· 45% Increase in Confidence

· 27% Increase in Consistency of Responses

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MSC QI Program Components

•Online Course

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MSC QI Program Components

• Educator facilitated review of online content

• Educator review of hospital specific policies and procedures

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Educator-facilitated simulation & debrief: 2-4 scenarios

• Includes an element of stress and/or real patient stories

• Process and clinical elements included

MSC QI Program Components

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Metric Reports

MSC QI Program Components

63%82%

95%

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Simulation Validation

Participation in a sepsis simulation training exercise resulted in Emergency Med Residents (n=20) taking more appropriate and immediate action in administering evidence-based care to patients.7

Following simulation training, participants noted improvement in confidence levels in managing patients with severe sepsis and septic shock.8

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Sepsis Program Benefits

• Documentation of staff competence and compliance

• Consistent training across all staff

• Integration into hospital quality improvement

programs

• Program based on guidelines, tools and research

from: • Surviving Sepsis Campaign • Institute of Healthcare Improvement (IHI) • Latest research studies related to the treatment of sepsis

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Sepsis Program Objectives

1. DESCRIBE THE DIFFERENCE BETWEEN SEPSIS, SEVERE SEPSIS AND SEPTIC SHOCK

2. IDENTIFY SIGNS AND SYMPTOMS OF SIRS

3. DISCUSS ASSESSMENT FINDINGS CORRELATED WITH PATIENTS WHO ARE AT INCREASED RISK FOR SEPSIS (INDEX OF SUSPICION)

4. IDENTIFY SIGNS AND SYMPTOMS OF TISSUE HYPOXIA

5. IDENTIFY SIGNS AND SYMPTOMS OF ORGAN DYSFUNCTION

6. DISCUSS FLUID RESUSCITATION RECOMMENDATIONS AND GOALS ACCORDING TO THE SURVIVING SEPSIS CAMPAIGN GUIDELINES

7. IDENTIFY CORRECT EARLY IDENTIFICATION AND TREATMENT RECOMMENDATIONS ACCORDING TO THE SURVIVING SEPSIS CAMPAIGN GUIDELINES

8. DISCUSS RATIONALE FOR SEPTIC SHOCK TREATMENTS

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Epidemiology

• Sepsis is the leading cause of death for critically ill patients in the United States

• It is the tenth most common cause of death overall

• It accounts for 1-2% of all hospitalizations and for 25% of ICU bed utilization

• Projection for 2020 is 1,100,000 new cases of sepsis

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IHI Surviving Sepsis Process Measures

Process Measure Goals

• Timing of Blood Cultures

•Timing of Antibiotics

•Central Venous Pressure

•Central Venous Oxygen Saturation

• Low-Dose Steroid Administration

• Drotrecogin Alfa (Activated) Administration

• Glycemic Control

• Inspiratory Plateau Pressure

• Reliability

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Mortality

As sepsis progresses, mortality increases

20% for sepsis

40% for severe sepsis

Greater than 60% for septic shock

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Sepsis Audience

• Early Responders

ER

Med/Surg Nurses

• Acute Care

ICU

• Medical Staff

Residents

Fellows

• Multi-Disciplinary Team Integration

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Sepsis Continuum

SIRS

• A physiologic response of the endocrine axis and immune

systems

Sepsis • SIRS + a known or suspected infection

Severe

Sepsis• Sepsis + acute organ dysfunction

Septic

Shock• Severe sepsis + refractory hypotension

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Simulation and Sepsis

• A physiologic response of the endocrine axis and immune systems

Participants must determine if their patient meets SIRS criteria in a dynamic setting

•Is their hear rate > 90•Is their respiratory rate > 20•Do they have a temperature•Has their WBC value changed

SIRS

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Treatment

• Start Sepsis Resuscitation Bundle•Draw lactate•Draw blood cultures•Administer broad spectrum antibiotics• If hypotensive or lactate > 4 administer 20ml/kg fluid bolus over 30 min• Insert central line with ScvO2 and CVP monitoring capabilities

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• SIRS + a known or suspected infection

• Participants must determine if their patient is septic

•Thorough history and physical assessment•Asking questions/hands on assessment•What is their index of suspicion

Sepsis

Simulation and Sepsis

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Treatment

• Diagnosis of source•Line insertion•Appropriate admission orders (acute care setting)•Time appropriate interventions

• Antibiotic administration• Fluid administration

Simulation and Sepsis

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Sepsis + acute organ dysfunction

• Participants must recognize indications of organ failure

•Selecting and reviewing appropriate labs•Recognizing dynamic patient condition changes through continuous assessment•Assessing CXR, Echocardiograms and other diagnostic tools

SevereSepsis

Simulation and Sepsis

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Treatment

• Appropriate interpretation of lab values• Were correct labs drawn• Recognition of organ failure

• Increased respiratory support•Decreased UOP despite adequate fluid administration•Decreasing LOC

Simulation and Sepsis

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Severe sepsis + refractory hypotension

• Participants must recognize the signs and symptoms of septic shock symptoms

•Decreasing blood pressure• Insertion of appropriate invasive monitoring lines•Use of appropriate pharmacological medications•Knowledge of the management bundle

SepticShock

Simulation and Sepsis

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Treatment

• Participants must recognize refractory hypotnesion

• Implementation of appropriate vasopressor therapy• Norepinephrine, Dopamine,

•Understanding of ScvO2 and CVP values• Inotropic support

• Dobutamine

• Implementation of the management bundle• Corticosteroid administration• rhAPC administration• Glucose control• Protective ventilation

Simulation and Sepsis

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Test Your Knowledge

SimSuite Sepsis Program Pre-Online Course Knowledge Check

Available to Laerdal SUN Attendees

and theirHospital Staff

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Conclusion

Open for discussion and question