CREATING A PROTOCOL AND EDUCATING USERS

Creating a Protocol and Educating Users

The development of the sepsis bundles required careful thought and attention to those aspects fo care that are essential to the proper management of severely septic patients and those with septic shock. The purpose of creating change bundles is to articulate a clear framework of levers for change. Following the severe sepsis bundles will eliminate the piecemeal or inappropriate application of standards for sepsis care that characterizes the majority of clinical environments today. However, simply posting the bundles is unlikely to produce any change. It is essential to take the bundles and create a customized clinical protocol that fits the logistical and cultural needs of your institution.  

Teams should use the bundles to create customized protocols and pathways that will function well within their institutions. However, all of the elements in the bundles must be incorporated into the protocols. The protocols should mirror the bundles but allow flexibility to accommodate the specific needs of a local hospital. The severe sepsis bundles (and thereby the hospital’s protocol) form the basis for the measurements the team will conduct. If all the elements of the bundles are not incorporated into your customized protocol, then performance on the measures will suffer. 

A strong protocol will accomplish all of the items listed in the severe sepsis bundles. If the protocol designer pays careful attention to the details in the bundles, the protocol will score well on the severe sepsis quality indicators. Hospitals will want to publicize their efforts with regard to improving sepsis care and make the protocol an integral part of their rollout strategy. It is imperative to launch an educational imitative regarding the effort.

Protocol Development

CLICK HERE to view a sample flow diagram of fluid resusicatation protocol development process

Entering the severe sepsis bundles on the chart as if they were orders would result in many questions. Therefore, a protocol is necessary to implement the bundles. A customized protocol will not only adapt execution of the bundles to your hospital’s practice environment, but it will also reduce errors in the delivery of care and begin the key process of standardizing sepsis care at your institution. The two most important ways to eliminate errors in care are to: 

•   Reduce the number of steps involved in any process 
  
•   Adopt standardized routines   

The probability of making an error increases disproportionately as the number of steps in a process increases 

•    With a 25-step process there is a 5% probability of making an error
  
•    With a 50-step process there is a 39% probability of making an error 
  
•    With 100 steps the probability climbs to 63% 
   

The development of the bundles has pared the SSC guidelines down to as few instructions as possible. Standardization accounts for the next most substantial improvement in quality after evaluative steps. Standardization involves the use of the following at the local level tailored to individual practice environments: 

•   Protocols
  
•   Guidelines 
  
•   Care processes (pathways) 
  
•   Equipment 
  
•   Procedures 
   

The purpose of developing protocols is to build a collaborative environment and bring about change in the local culture. Hospitals that transform their care from chaotic practice environments characterized by individual preferences to one that operates in harmony under routine conditions also transform the staff’s attitude reagarding quality of care. By organizing many levels of the organization around a single package of care, the creativity and problem-solving abilities within an institution are unleashed. In contrast, protocols that are simply mapped onto a hospital’s care pattern, rarely succeed and rarely result in anyone in the institution taking ownership of them. Follow these steps to standardize care and create lasting changes in the practice environment