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The Surviving Sepsis Campaign in Your Institution: Getting Started

The Surviving Sepsis Campaign (SSC) has partnered with the Institute for Healthcare Improvement (IHI) to incorporate their “bundle concept” into the diagnosis and treatment of patients with sepsis, severe sepsis and septic shock. We believe that improvement in the delivery of care should be measured one patient at a time, through a series of incremental steps that will eventually lead to systemic change within institutions and larger health care systems.

Local SSC implementation is the key to mortality reduction for severe sepsis and septic shock patients. Successful SSC adoption requires a hospital champion who can coordinate the LEADER steps outlined below.

  • Learn about sepsis and quality improvement by attending local and national sepsis meetings.
  • Establish a baseline in order to convince others that improvement is necessary and to make your measurements relevant. This should be done prior to formal improvement efforts. Start by collecting data on all severe sepsis patients in your intensive care unit (ICU) - you may see only one or two patients per day.
  • Ask for buy-in from institutional leadership and seek initial support from the emergency department (ED) and ICU staff and directors, quality improvement personnel, nursing staff and others. Form a sepsis team and bring all stakeholders to the table for input. Tell people what you are doing and why. You may not receive initial support across the board, but opinions often change when data starts to become available. Publicize the SSC with a formal kick-off event. Highlight several physicians to speak about the effort and invite representatives from administration, medicine, nursing, respiratory therapy, and pharmacology. This commitment will provide early momentum and drive improvement efforts forward.
  • Develop an institution-specific SSC protocol comprising all bundle elements. Seek feedback and refine your protocol to the satisfaction of your team. Assign a “protocol owner” with the task of refining the protocol and patiently obtaining feedback from all stakeholders. Invite comments and suggestions at regular team meetings. Publish refinements by scheduled deadlines and label each version with a date to ensure uniformity of use.
  • Educate stakeholders in the ED and ICU according to shift schedules. Post the SSC protocol in several prominent locations. Familiarize staff with the bundles and your protocol. Explain the importance of the bundle tools. Tolerate failure and revise teaching as needed. Remediate errors and anticipate obstacles along the way.
  • Recount successes and failures every month. The SSC database can create graphs that benchmark your success and demostrate powerful visuals of clinical targets where improvement is important. Everybody involved needs to see what is happening to drive the SSC effort forward. Identify critical failure modes as a team and redesign processes as needed while simultaneously measuring your results.

Measuring Improvement to Effect Change: Tools for Success

The partnership with the IHI includes the development of several mechanisms for quality improvement measurement. Use the tools below as they are or alter them to suit your individual team and hospital needs:

  • Evaluation for Severe Sepsis Screening Tool: proper identification of patients with severe sepsis is imperative. This one-page form guides the user through a simple check-box algorithm and can be used in the ED triage area, on the wards, and in the ICU for screening purposes. A positive screen for severe sepsis prompts the user to place the patient on the protocol. During baseline collection, the form validates data collection for a given patient.
  • Individual Chart Measurement Tool: all severe sepsis patients will need to arrive in the ICU at some point in their care presuming they survive to ICU admission. The data collector should apply the four-page Individual Chart Measurement Tool to each patient.
  • SSC Implementation Manual and Database:  The manual is a user guide for participating in the Surviving Sepsis Campaign. It explains the sepsis bundles and individual improvement measures and guides you through the important data collection process. The manual can be downloaded, printed, and binders created at your hospital for your team. It is not currently available in hard copy. The database provides you with the option to send your results to the SSC. For documentation on the central database's compliance with HIPAA, please contact the campaign at info@survivingsepsis.org. We strongly encourage monitoring and reporting of data to help everyone as they learn how to improve. Graphs should be placed in every department that cares for septic patients.

Communicating Progress with Global SSC Efforts

Sharing your experience with members of your local network and global SSC partners is an important part of the process improvement effort. To join the listserve please visit http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org to enroll. Joining the list serve will also enable the campaign to send you "Campaign Update" the bi-monthly campaign newsletter. Please note that the list serve is closely monitored to assure that you will receive only pertinent materials. You may unsubsribe at any time.

Education

The SSC leadership believes that continuing education is the most important factor for initial and ongoing SSC success. A variety of educational tools is available to network institutions to support the learning process. Teaching tools include:

For further assistance, please contact Lori Harmon by phone at 847-493-6403 or by email at lharmon@sccm.org.