Improving the management of sepsis in a district general hospital by implementing the 'Sepsis Six' recommendations

Abstract

Sepsis is a common condition with a major global impact on healthcare resources and expenditure. The Surviving Sepsis Campaign has been vigorous in promoting internationally recognised pathways to improve the management of septic patients and decrease mortality. However, translating recommendations into practice is a challenging and complex task that requires a multi-faceted approach with sustained engagement from local stakeholders.Whilst working at a district general hospital in New Zealand, we were concerned by the seemingly inconsistent management of septic patients, often leading to long delays in the initiation of life-saving measures such as antibiotic, fluid, and oxygen administration. In our hospital there were no clear systems, protocols or guidelines in place for identifying and managing septic patients.We therefore launched the Sepsis Six resuscitation bundle of care in our hospital in an attempt to raise awareness amongst staff and improve the management of septic patients. We introduced a number of simple low-cost interventions that included educational sessions for junior doctors and nursing staff, as well as posters and modifications to phlebotomy trolleys that acted as visual reminders to implement the Sepsis Six bundle.Overall, we found there to a be a steady improvement in the delivery of the Sepsis Six bundle in septic patients with 63% of patients receiving appropriate care within one hour, compared to 29% prior to our interventions. However this did not translate to an improvement in patient mortality.This project forms part of an on going process to instigate a fundamental culture change among local healthcare professionals regarding the management of sepsis. Whilst we have demonstrated improved implementation of the Sepsis Six bundle, the key challenge remains to ensure that momentum of this project continues and forms a platform for sustainable clinical improvement in the long term.

Managing sepsis: Electronic recognition, rapid response teams, and standardized care save lives

“…Other studies of sepsis bundle implementation have yielded mixed results. One study by Kumar et al demonstrated improved compliance to the sepsis six (oxygen, blood cultures, antibiotics, lactate measurement, intravenous fluids, and urine output monitoring) from 29% pre-intervention to 63% post-intervention, but without demonstrable improvement in outcomes [18]. However, most studies indicate improved outcomes even with modest adherence to bundled care [9] [19–22].…”

Impact of a hospital‐wide sepsis pathway on improved quality of care and clinical outcomes in surgical patients at a comprehensive cancer centre

“…Patients were eligible for the pathway if two or more of the systemic inflammatory response syndrome (SIRS) criteria or a systolic blood pressure of <100 mm Hg were present in a ward setting. Key components of the pathway included establishing intravenous access, drawing two sets of blood cultures prior to administration of antibiotics, and performing venous lactate measurements and a full blood examination (Burrell et al, ; Kumar, Jordan, Caesar, & Miller, ; Mattison, Bilney, Haji‐Michael, & Cooksley, ; Morneau, Chisholm, Tverdek, Bruno, & Toale, ; Box ). Following organisation‐wide education and development of a dedicated checklist for pathway components (embedded in patient medical record), the program was implemented across all wards in March 2013.…”

“…Key components of the pathway included establishing intravenous access, drawing two sets of blood cultures prior to administration of antibiotics, and performing venous lactate measurements and a full blood examination Kumar, Jordan, Caesar, & Miller, 2015;Mattison, Bilney, Haji-Michael, & Cooksley, 2016;Morneau, Chisholm, Tverdek, Bruno, & Toale, 2017; Box 1).…”

Successful prospective quality improvement programme for the identification and management of patients at risk of sepsis in hospital

“…Therefore, SIRS is widely used as part of screening tools for patients at risk of sepsis. SIRS is also often used for case identification in sepsis quality improvement work 7 8…”