Background, Rationale, and Suggested Implementation Strategies
Developing Institutional Guidelines
- Develop institutional guidelines, locally adapted from national and example hospital guidelines, for identification and treatment of sepsis. If institution specific guidelines already exist, they should comply with the following:
- Hospital onset sepsis - Institutional guidelines should include:
- Standardized process for screening for sepsis upon presentation and throughout hospitalization
- Clinical evaluation(labs, diagnostic studies, imaging etc.)
- Antimicrobial selection
- Source control
- Fluid resuscitation(indications, contraindications, type, and volume of fluid)
- Antimicrobial narrowing and stopping
- Patient and family education on sepsis
- Peri-discharge management
- Integrate recommendations into key processes within the healthcare system such as into order sets, individual orders, discharge planning/processes, required yearly education for staff, etc.
Guideline Implementation - Order Sets and Screening Processes
- Develop and implement order sets for management of sepsis
- Develop and implement sepsis screening process for early identification of sepsis upon presentations and throughout hospitalization.
- Explore training rapid response teams in sepsis recognition and care.
- Develop structures and processes to facilitate prompt delivery of antimicrobials.
- Develop a standardized process for sepsis management including:
- Screening
- Clinical evaluation
- Diagnosis
- Antimicrobial selection
- Source control
- Fluid resuscitation
- Indications for treatment escalation
- Antimicrobial narrowing and stopping
- Patient and family/caregiver education
- Peri-discharge management
Guideline Implementation - Multidisciplinary Handoffs & Discharge Practices
- Develop structures and processes to support effective hospital hand-offs in patients with sepsis.
- Develop processes to evaluate patients prior to discharge and refer to appropriate resources post discharge to support recovery from sepsis.
Guideline Implementation - Educating Providers and Patients/Families
- Educate providers, including hospitalists, internal medicine, family medicine, emergency medicine physicians, residents, advanced practice professionals(APPs), and nursing staff about sepsis, early identification, sepsis management, their role in team-based sepsis care and post sepsis syndrome.
- Provide written and verbal education on sepsis to patients and families. Education should include: what is sepsis, increased risk for subsequent episodes of sepsis, when to suspect sepsis, when to seek evaluation for potential sepsis and post sepsis syndrome.
- During educational sessions, highlight HMS data, showing opportunities for improvement.
- Communicate and promote institution-specific guidelines with frontline providers, including physicians, APPs, nursing, and pharmacy to ensure use of recommendations(morning report, grand rounds, medical staff meetings, division meetings).
- Build systems that can help modify provider behavior. Examples include(but are not limited to): clinical decision support tools.
- Consider social factors in marketing guidelines to frontline providers. Highlight their participation in creation of the guidelines, and try to overcome viewpoints of loss of provider autonomy. Instead, emphasize improvement in quality and outcomes.
- Involve champions in the education and dissemination process.