Take the Shock Out of Sepsis
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Why Use Simulation?
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Simulation in Aviation
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Miracle on the Hudson
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A Changing Landscape
© Medical Simulation Corporation 2009
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Blended Learning
On-Line Course
Didactic Review
Debrief
Simulation
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The Application of Simulation
Putting the Guidelines into Practice
Understanding the
Guidelines
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Standardized Metrics
Individualized Feedback
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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MSC QI Program Components
Educator-facilitated simulation &
debrief: 2-4 scenarios
•
•
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Includes an element of stress and/or
real patient stories
Process and clinical elements included
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Metric Reports
95%
82%
63%
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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:
•
•
•
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Surviving Sepsis Campaign
Institute of Healthcare Improvement (IHI)
Latest research studies related to the treatment of sepsis
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
• Low-Dose Steroid
Administration
• Drotrecogin Alfa
(Activated)
•Central Venous PressureAdministration
•Timing of Antibiotics
•Central Venous Oxygen • Glycemic Control
Saturation
• 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 + acute organ dysfunction
Sepsis
Septic
Shock
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• Severe sepsis + refractory hypotension
Simulation and Sepsis
SIRS
•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
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Simulation and Sepsis
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
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Simulation and Sepsis
Sepsis
•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
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Simulation and Sepsis
Treatment
•Diagnosis of source
• Line
insertion
• Appropriate admission orders (acute care setting)
• Time appropriate interventions
Antibiotic administration
• Fluid administration
•
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Simulation and Sepsis
Severe
Sepsis
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
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Simulation and Sepsis
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
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Simulation and Sepsis
Septic
Shock
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
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Simulation and Sepsis
Treatment
•Participants must recognize refractory
hypotnesion
• Implementation
therapy
•
of appropriate vasopressor
Norepinephrine, Dopamine,
• Understanding
of ScvO2 and CVP values
• Inotropic support
•
Dobutamine
• Implementation
of the management bundle
Corticosteroid administration
• rhAPC administration
• Glucose control
• Protective ventilation
•
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Test Your Knowledge
SimSuite Sepsis Program
Pre-Online Course
Knowledge Check
Available to
Laerdal SUN Attendees
and their
Hospital Staff
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Conclusion
Open for discussion and
question
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