msc confidential take the shock out of sepsis. msc confidential why use simulation?
TRANSCRIPT
MSC Confidential
Take the Shock Out of Sepsis
MSC Confidential
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
Simulation and Sepsis
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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