I am new to quality. I started in April of this year and have been mostly focusing on core, internal studies, ndnqi, mbqip, etc. I have been recently asked to take up sepsis with very little education on it so i'm reaching out to see how you all deal with the education part of sepsis. My director is wanting me to learn to severe sepsis and septic shock bundles and criteria, and abstracts, and then go and catch the physicians and have a "discussion " with them about it. To me this feels nonproductive. Should this not be presented as an educational opportunity for the physicians to participate in? Maybe like in a meeting or something somehwat formal? It may be that I'm new and I still don't quite understand my role in educating hospital staff on charting etc, but how do you all present your information to drive change?
Oct 6, '16
Welcome to the interesting and ever changing world of Quality! I have been working in Quality for 8 years. Sepsis is an interesting measure! I suggest checking out the Quality Net website for the current guidelines you can find them in the specification manuals.
We sent out an informational letter to all physicians, PA's and NP's in the hospital outlining the criteria for severe sepsis and septic shock. I had the support of our VPMA (Vice President of Medical Affairs) and our Infection Control physician. Unless you are going to do concurrent review on all patients admitted with a diagnosis of sepsis, its going to be near impossible for you to "go and catch the physicians". You might consider putting together a power-point presentation. Maybe talk to your Medical Staff department and see about offering CEU's for the presentation.
We have a monthly Sepsis committee that meets, including an ER physician, the infection prevention physician, the RN Director of the ER, the ICU director, the manager of the lab (deals with the blood culture timing issues) and myself, I do the abstraction of charts. We go over the OFI's (opportunity for improvement) and drill down to the cause. If it is nursing related, that nurse is given a refresher regarding using critical thinking when looking at the antibiotic orders, making sure the blood cultures were already drawn prior to starting the antibiotics, etc.. If it is physician related, choosing the appropriate antibiotic, down to what the focused exam must include, ordering the repeat lactate to be drawn prior to 6 hours after presentation, ordering the correct amount fluids (this is a big one for us), they are reminded.
I would make sure your educators are aware of the criteria as well they can assist with some of that education especially for new grads.
Sepsis is a tricky measure, a lot of variables!!