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Fighting Sepsis in the Geriatric Patient Not always a cruise

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Fighting Sepsis in the Geriatric Patient Not always a cruise Introduction Infections are a focus of the regulatory bodies, so much so: We now have to report deaths ... – PowerPoint PPT presentation

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Title: Fighting Sepsis in the Geriatric Patient Not always a cruise


1
Fighting Sepsis in the Geriatric Patient
  • Not always a cruise

2
Introduction
  • Infections are a focus of the regulatory bodies,
    so much so
  • We now have to report deaths related to
    Healthcare Acquired Infections
  • Hospital reimbursement will soon be related to
    performance how low is your infection rate?

3
Why did we select our project?
  • Significant Cost for patients and healthcare
  • Range per ICD 9 code
  • 38,000 to 73,000 dollars on the low end
  • LOS is elevated thus high utilization of patient
    resources
  • ICU LOS 6.9 days with hospital stay at 16 days
  • High Incidence of sepsis in geriatric population
  • Elderly patients (gt 65yrs of age) 12 of
    population 65 of sepsis cases
  • Martin GS, Mannino DM, Moss M. The effect
    of age on the development and outcome of adult
    sepsis. Critical Care Medicine 2006 3415-21.

4
More Reasons turbulent water ahead
  • Opportunity to improve outcomes
  • Mortality is 30 to 60
  • Sepsis cases are expected to increase with 1.1
    million cases within the next 15 years
  • Laine G. SLEH Sepsis Initiative Early
    Clinical Financial Outcomes (Power Point
    Presentation). 2007 SLEH.

5
Target population for our project
  • Medical/Surgical Units
  • Geriatric Patients
  • PURPOSE
  • To increase awareness and education
  • To support early identification so that staff can
    intervene early and save lives

6
Needs Assessment
  • Need to Expand sepsis protocol to patient floors
    (beyond ICU and ED).
  • Will impact floor nurses, PCAs, M.D.s, rapid
    response teams, pharmacists (anyone involved in
    patient care).

7
Needs Assessment We recognized that
  • Failure to rescue patients is real and happens
    everyday in healthcare
  • Most codes occur in non ICU environments
  • Many codes may be related to consequences of
    infections (hypovolemia, hypotension etc)
  • Most non ICU nurses do not have extensive
    knowledge about sepsis in the elderly

8
Needs Assessment
  • Potential Benefits
  • Decrease Mortality
  • Decrease transfers to ICU for sepsis
  • Improve LOS through early recognition
  • Improve Nursing satisfaction
  • Improve utilization of patient resources
  • Reduce pharmacy costs
  • Reduce overall costs
  • Improve patient satisfaction

9
Needs Assessment
  • Agency Resources Supporting CAP
  • - Senior Management
  • Education
  • Pharmacy
  • 7S3 Management and Staff
  • 20T and 21T Management and Staff

10
Review of Literature
  • Martin GS, Mannino DM, Moss M. The effect of age
    on the development and outcome of adult sepsis.
    Critical Care Medicine 2006 3415-21.
  • Rudis MI, Rowland KL. Current Concepts in Severe
    Sepsis and Septic Shock. Journal of Pharmacy
    Practice 2005 18.5351-362.
  • Destarac LA, Ely E W. Sepsis in Older Patients
    An Emerging Concern in Critical Care. Advances in
    Sepsis Vol 2 No 1 2002 15-22.
  • Levy M, Fink M, Marshall J, Abraham E, Angus D,
    Cook D, Cohen J, Opal S, Vincent J, Ramsay G.
    2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis
    Definition Conference. Intensive Care Medicine
    2003 29 530-538.
  • Treige N, Laine G. Surviving Sepsis (Power Point
    Presentation). 2006 SLEH.
  • Laine G. SLEH Sepsis Initiative Early Clinical
    Financial Outcomes (Power Point Presentation).
    2007 SLEH.

11
Project Model Purpose and Goals of the CAP
  • To define SIRS, Sepsis, septic shock in the in
    the adult and geriatric patient population
  • To introduce the Sepsis Protocol to nurses on a
    medical surgical floor so that earlier
    intervention can begin

12
Project model Goals Cont.
  • To review Early Goal Directed Therapy in the
    geriatric patient
  • To teach inclusion and exclusion criteria for the
    Sepsis Protocol
  • To introduce Sepsis Management of the geriatric
    patient to nurses on a medical/ surgical floor

13
Behavioral Objectives The learner will be able
to
  • Define SIRS, Sepsis, septic shock
  • Explain the Sepsis Protocol
  • List Early Goal Directed Therapy in the geriatric
    patient
  • List inclusion and exclusion criteria for the
    Sepsis Protocol
  • Describe Sepsis management in the geriatric
    patient

14
Expected Outcomes
  • Short term
  • Increase knowledge base about sepsis in the
    geriatric patient versus the adult patient
    population
  • Increase knowledge of early intervention
    strategies
  • Long Term
  • Increase early recognition of sepsis and early
    interventions
  • Increase early fluid resuscitation on medical
    units
  • Reduce transfers to ICU
  • Reduce pharmacy and overall cost
  • Reduce LOS in the ICUs

15
Project methodology and activities
  • Reviewed current cost of ICD 9 codes
  • Literature search
  • Develop an in-service/poster presentation
  • Developed and laminated screening guides
  • Developed pre and post test
  • Provided in-service/testing for 43 RN staff
  • Provided in-service/testing for (3 PCAs)
  • Aggregated data

16
Project Cost Analysis
  • RN time 88 hours (2640.00)
  • Brainstorming
  • Literature search
  • Project design
  • Development of poster/in-service
  • Education time to give the in-service
  • Lamination of quick reference cards (100.00)
  • Office supplies (80.00)
  • Lamination supplies
  • Ink and paper
  • Poster
  • ESTIMATED COST 2820.00

17
Evaluation of Outcomes
  • Pre versus Post test scores
  • In-service evaluation
  • Need to develop tool (underway)
  • Review number of transfers to ICUs related to
    geriatric sepsis
  • Track LOS for geriatric sepsis patients
  • Began tracking by age groups
  • lt65 years of age
  • 65 to 75 years of age
  • gt75 years of age
  • Effectiveness can increase by rolling this out
    house wide
  • Commitment to be determined by Senior Management

18
Evaluation of Outcomes
19
Geriatric Specific Questions
20
Outcomes
  • Post-test results significantly improved from
    pre-test results From 61 to 98 overall.
  • Results indicate sepsis education needed Pre
    in-service knowledge base of sepsis was low
    despite high rate of sepsis patient populations.
  • Geriatric specific education needed Pre
    in-service geriatric specific knowledge base was
    also low despite high geriatrics population.
  • Results show the need for removal or rewording of
    question 4 on pre/post test.

21
Summary Conclusions
  • Literature reviewed, project designed.
  • In-servicing developed and provided.
  • Pre and Post tests administered.
  • Data collection and analysis completed.
  • With hospital wide initiation of early fluid
    resuscitation we can further reduce overall LOS,
    cost and mortality.

22
Conclusions
  • Strengths
  • Receptive staff
  • Interested medical staff
  • Retrospective data available
  • Real need to expand study house wide
  • Incidental finding of need for further education
    for the geriatric patient population

23
Conclusions
  • Limitations of design
  • Limited demographic data collected from those
    tested
  • Post evaluation of in-service limited to verbal
    comments only
  • Tool not readily available
  • Length of time available for CAP project
  • Possibility of unreliable/invalid test question
  • Poorly worded test question (number 4)

24
Conclusion
  • Limitations of implementation
  • Limited time for formal and comprehensive
    in-servicing of staff nurses.
  • Limited knowledge base of the pathophysiology and
    treatment of sepsis.
  • Limited knowledge of treating sepsis in the
    geriatric population.

25
Thank you
  • Tisha Norman RN ICU 7S3
  • Mellissa Howell RN 21T
  • Jennifer Hoffman RN 20T
  • Petra Grami RN ICU 7S3
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