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Sepsis Education And Prevention Video Final Working Draft 6 29 09


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  • 1. Sepsis Education and Prevention For Piedmont Healthcare Final WORKING Draft June 29, 2009 Submitted by: Michele Glazer Page 1 of 11
  • 2. Sepsis Education and Prevention Audio Video GRAPHIC TITLE: MUSIC UP: Narrator: (V.O.) Piedmont Healthcare’s Sepsis Collaborative Presents…Severe Sepsis Prevention. The McLean-Piedmont Method for Arresting Sepsis. Music Transition into Video Montage Insert: Video Montage of Interviews – 8-10 second effect transition with sound bites from interviews DISSOLVE TO: Dr. Hamby: By definition, sepsis is a term used INT. ICU Nursing Station: Dr. Hamby (O.C.) to define a continuum of problems. In general, Title: Dr. Leigh Hamby, M.D., EVP/Chief Medical it means infection of the blood stream Officer/Chief Quality Officer accompanied with a profound inflammatory response. And while that sounds like a relatively non-serious explanation, complications from exacerbated sepsis or severe sepsis, can be life threatening. Severe sepsis is an expression of multi-organ dysfunction created by both an un-contested pro-inflammatory and hyper coagulation syndrome. Those clots block small vessels, impacting normal flood flow to vital organs. Both inflammatory organ attacks as well as ischemia from lack of blood flow affect many organs and may cause them to operate in a dysfunctional manner, even to completely fail. Early diagnosis is crucial, since one third of the patients diagnosed with sepsis die from the complications associated with it. MUSIC TRANSITION GRAPHIC: NARRATOR (V.O.): So exactly how common is 750,000 Cases of Severe Sepsis Annually in the U.S. sepsis? (Angus, Crit Care Med 2001) Page 2 of 11
  • 3. More than 750,000 cases of severe sepsis occur each year in the United States, with a mortality rate at around 30%. GRAPHIC Slide #2 on A sepsis death occurs every 2 ½ minutes. In the United States, approximately 1,400 people die every day from severe sepsis, making it the 10th most common cause of death. Annual death rates from sepsis rank higher than other Major Diseases such as heart attack or stroke. In fact, 10% of all patients admitted to the ICU are diagnosed with sepsis. CD And the issue is not limited to human cost. The GRAPHIC: economic cost to the country is roughly $17 Sepsis Healthcare Cost: $17,000,000,000 annually billion each year. DISSOLVE TO: Music Transition Slide #3 – Erin Flatley Narrator (V.O.) - Erin Flatley from Dunedin, Florida was 23 years old when she underwent a simple hemorrhoidectomy procedure in 2002. Her father, Dr. Carl Flatley, said he had no idea what to watch for when Erin developed sepsis. Erin went into the hospital for a minor hemorrhoid operation and five days later was dead from sepsis. Slide #4 – Mariana Bridi de Costa NARRATOR: Brazilian model Mariana Bridi da Costa was a healthy 20-year-old when doctors told her she had a urinary tract infection, her family says. The infection spread, and after amputating her feet, then her hands, doctors thought they had the situation under control. Four days later, da Costa was dead. Mariana Bridi da Costa, Brazilian model Page 3 of 11
  • 4. Slide #5 NARRATOR: And what began as a case of pneumonia in 1990 for Muppets creator Jim Henson, resulted in his death from sepsis at the age of 53. Jim Henson, Muppets creator CUT TO: Music Transition GRAPHIC – Slide #6 NARRATOR: So how CAN we reduce sepsis mortality? Slide #7 – Sepsis Team Narrator: Well, Piedmont accomplished just that. By creating a joint effort among multiple organizations that share resources and information. By creating a collaborative between all of Piedmont’s hospitals, along with Chief Quality Officer Dr. Leigh Hamby, and the sepsis expert, Barbara McLean. And by establishing a procedure for early recognition and treatment, which in turn, has resulted in a significant impact on the reduction of sepsis mortality. Animate pic – separate into quadrants then recover Page 4 of 11
  • 5. Graphic: - Slide #8 MUSIC TRANSITION NARRATOR: Beginning in February 2004 Piedmont Healthcare initiated methods to detect severe sepsis, and implement the evidence-based guidelines proposed by the surviving sepsis campaign. Eventually, Piedmont formed The Sepsis Collaborative in January 2007. An international sepsis expert, Barbara McLean came on board to assist with developing methods for an earlier diagnosis and Cut To: treatment protocol. Interview with Barbara McLean (see specific segment [INSERT BARBARA MCLEAN SOUND BITE] – “…It in audio) seemed to be a simple extension that if we could identify those patients at risk for sepsis, via a vigilant analysis, that we could treat with volume and BSA while diagnosing and do both within 60 minutes of initial identification. The DISSOLVE TO: strategy was to prevent sepsis from evolving…” GRAPHIC: NARRATOR: Now we had a new goal: Reducing Guidelines: morality by early recognition and treatment. Evaluate and Identify Treatment The team established guidelines to evaluate Understanding Pathophysiology and identify patients at risk for severe sepsis. An ongoing education program included GRAPHIC – Slide #9 definition, recognition, treatment and explaining the pathophysiology of sepsis, severe Recognize Sepsis sepsis and septic shock. S evere S epsis This collaborative has helped establish a Prevention P ackage = procedure for early recognition and treatment, In 60 minutes: which in turn, has had the biggest impact on 20 ml/kg IV Fluid, the reduction of sepsis mortality. Blood Culture and IV Antibiotics The goal of the collaborative consisted of a simple directive: Fluid, Culture and Antibiotics in 60 Minutes. CUT TO: Page 5 of 11
  • 6. Dr. Hamby (O.C.): Early recognition and INT. ICU Nursing Station – Dr. Hamby O.C. aggressive resuscitation initiated within the first Cut to: hour has reduced mortality in our system by as (Split screen: Dr. Hamby with following graphic?) much as 34%. Graphic: Slide #10 Sepsis Mortality: [PAUSE] PIEDMONT HEALTHCARE 18.00% 16.00% 14.00% 12.00% 12.98% 10.00% 8.00% 8.93% 6.00% 4.00% 2.00% 0.00% FY2007 (n=2271) FY2008 (n=3247) Dr. Hamby: If we can improve our methods of how we treat sepsis, we can improve our outcomes. We can save lives. ISO on Dr. Hamby for final line CUT TO: CUT TO: Narrator: Several healthcare providers share Open on Freeze of Dr. Core interview their experiences as they followed the McLean- Piedmont collaborative. MUSIC TRANSITION: INSERT : PHYSICAN/STAFF INTERVIEWS PHYSICIAN/STAFF INTERVIEWS DISSOLVE: MUSIC TRANSITION: GRAPHIC: Slide #11 NARRATOR: Piedmont’s Sepsis Evaluation Process relies heavily on an algorithm -- the McLean-Piedmont Method – which aids the clinician in evaluating patients that are at high risk for sepsis. It helps to identify the patient at risk for sepsis and assists with monitoring those patients in the continuum of the disease process should it progress from Uncontrolled Inflammation… to sepsis… to severe sepsis, and escalating into septic shock. Page 6 of 11
  • 7. Evaluation Process NARRATOR: Referring to Category A in the Evaluation Process - once there is a suspicion of infection and/or exposure to infection, the patient receives one point for each item checked in his or her Clinical Suspicion such as lung infection; trauma, exposure to illness, chemotherapy, altered mental status, recent abortion, recent antibiotic therapy, chills or fever and any indwelling catheters. Evaluation Process NARRATOR: And the patient receives one point for exposures in the hospital such as surgery; all GRAPHIC: (create on Avid) indwelling catheters such as a central line, a Patient has history of, but not limited to: pulmonary artery catheter, a vas-cath and a Lung Infection femoral sheath; any urinary catheters; Trauma ventilation procedures; open wounds and Exposure to Illness antibiotic therapy. Chemotherapy Altered Mental Status Recent Abortion Recent Antibiotic Therapy Chills / Rigor / Fever Indwelling Catheters NARRATOR: So in looking at the Category A block, the Clinical Suspicion area…a patient GRAPHIC: (create on Avid) suspected of sepsis would receive one point for Exposures in Hospital each Clinical Suspicion checked in this category. Surgery A strong clinical suspicion of the involved Indwelling Catheters practioners is also considered as a qualifier of Urinary Catheter suspicion. Largely, since Sepsis sources are vast Ventilated Patients and sometimes impossible to recognize early. Open Wounds Currently on Antibiotics GRAPHIC: Slide Page 7 of 11
  • 8. Evaluation Process NARRATOR: For example… let’s say the patient under your care, we’ll call her Mrs. Smith, has an upper respiratory infection and a Triple Lumen catheter. Mrs. Smith would receive two points in Category A. NARRATOR: Let’s look at the second level of our algorithm, the SIRS portion - Systemic #12 Inflammatory Response Syndrome, or Uncontrolled Inflammation throughout the INT. PATIENT ROOM – Nurse and Patient entire body… Patient in bed. Nurse providing care; checking vitals NARRATOR: Clinical signs of SIRS consist of a central temperature greater than 101° F or less than 96.8 °F. A sustained heart rate of greater GRAPHIC: Create on Avid than 90 beats per minute. A sustained respiratory rate of greater than 20 breaths per S – Systemic minute. The heart rate and respiratory rate I – Inflammatory must be measured at least two different times, R – Response at least five and no more than 15 minutes apart. S – Syndrome NARRATOR: Again, utilizing the point system, GRAPHIC: Slide #13 your patient receives one point from the B category for each of the clinical signs of SIRS. Evaluation Process Mrs. Smith has fever of 101.7° and a persistent heart rate of 100 - 104. You would assign her two points from Category B – temperature and heart rate. NARRATOR: The final category of the algorithm, Category C, focuses on the patient’s blood pressure. Is the systolic blood pressure less than 90 mm Hg or has it decreased by 20 mm Hg from the previously measured systolic CUT TO: blood pressure? For example, if the blood INT. PATIENT ROOM – Nurse and Patient pressure is 89/60, then the patient would Nurse taking patient’s temp. receive two points automatically for having systolic hypotension. CUT TO: NARRATOR: So what do we do with this information? Graphic – Slide #14 Page 8 of 11
  • 9. To meet the clinical criteria, Category A must have at least one item checked in order to suspect sepsis. And at least two different categories must have check marks in them. To diagnose Sepsis, we must have at least one item in Category A checked and any combination of items from the other two categories, so that the evaluation totals three points. To proclaim a sepsis judgment, three total points must be measured in at least two categories and one of those must be Category CUT TO: A. We add up the total from all 3 categories. For INT. PATIENT ROOM – NURSE and PATIENT example, our patient Mrs. Smith, with a Nurse taking blood pressure, marking logarithm chart, diagnosis of pneumonia… a temp of 101.7°… monitoring clock. and a heart rate of 100 - 104. She has an evaluation total of three points. CU – Evaluation Process chart in Nurse’s hands – Nurse marking chart (?) Totaling chart – 3 points. We suspect sepsis. SFX: Ticking Clock… GRAPHIC: Create on Avid SUSPECT SEPSIS! NARRATOR: And now the time clock starts ticking… GRAPHIC – Clock Slide #15 NARRATOR: With haste the caregiver should proceed with fluid resuscitation, collect blood Graphic – Slide 16 cultures, lactic acid and other labs, and begin antibiotic administration. Every 15 minutes, vital signs should be checked until stable. Every hour, organ dysfunction should be evaluated. MUSIC TRANSITION Page 9 of 11
  • 10. DR. HAMBY: The Severe Sepsis Prevention CUT TO: procedure is a relatively low cost operative with little chance of negative patient outcome. And the evidence-based medicine supports the theory. INT. ICU Nursing Station - DR. Hamby (O.C) Initiating this protocol within a 60 minute CUT TO: timeframe has been widely successful at Piedmont Hospital in reducing sepsis mortality GRAPHIC: - Slide 17 rates in ICU admits. Mortality Rate for ED Admits with ICU stay (Angus Codes +) 0.3 0.25 0.2 Proportion Dying 0.15 0.1 In fact, since 2007, Piedmont Hospital, 0.05 Piedmont Fayette Hospital and Piedmont Mountainside have reduced the mortality rate 0 Dec- Jan- Feb- Mar- Apr- May- Jun- 05 06 06 06 06 06 06 Jul- Aug- Sep- Oct- Nov- Dec- Jan- Feb- Mar- Apr- May- Jun- 06 06 06 06 06 06 07 07 07 07 07 07 Jul- 07 Aug- Sep- Oct- Nov- 07 07 07 07 of patients coming to the Emergency GRAPHIC – Slide 18 Department with Sepsis by 30-40%. PIEDMONT HEALTHCARE: Sepsis Collaborative Sepsis Patients - Calculated # Lives Saved 700 611 600 500 400 300 227 214 Part of this is better recognition of Sepsis, 200 170 however not all of the improvement appears to 100 be due to categorizing more patients as having 0 FY07 FY 08 FY09 (Jun - Dec) GRAND TOTAL sepsis. One patient speaks for himself… LIVES SAVED CUT TO: INT. ICU NURSING STATION – Dr. Hamby on camera [Interview with Gordon Perry] NARRATOR: After a misdiagnosis at another CUT TO: area hospital without a sepsis protocol, Mr. Gordon Perry was admitted to Piedmont in full GRAPHIC – Slide #19 septic shock and perhaps moments away from multi-system organ failure. He was immediately treated following the sepsis protocol, the McLean-Piedmont method. This life-saving measure resulted in Mr. Perry’s complete recovery from septic shock. [Insert sound bite – “…I just can’t say enough…”+ CUT TO: Page 10 of 11
  • 11. NARRATOR: But the change in sepsis protocols on paper is easy… encouraging the change in Interview with Gordon Perry – final paragraph personal practice takes more time and effort. Dr. Hamby: *Insert ad lib: “We recognize that it’s not a formula, not cookbook medicine, and the collaborative doesn’t override a physician’s critical thinking skills in determining the best course for a patient…”+ The Sepsis INT. ICU Station – Dr. Hamby (O.C) – Medium shot Collaborative at Piedmont Healthcare has established a procedure for defining Severe Sepsis as well as initiating a process to disrupt the pathophysiology of Severe Sepsis. (Pause) We’ve come a long way in increasing positive patient outcomes. And by continuing with these measures, we look forward to more stories of FADE OUT: success. Credits MUSIC OUT Page 11 of 11