Background Sepsis 6 delivery is challenging in the undifferentiated ED patient. Despite a sepsis project team within the ED the compliance with the bundle had reflected the challenging nature of the task (a mean compliance of 20%). Our hypothesis for improvement was that a combination of process mapping and in situ simulation training coupled with immediate reflective video feedback could improve our ability to provide timeous delivery of antibiotics.
Aim 80% of patients with sepsis will have antibiotic delivery within 1 h of identification by august 2014.
Method Process Mapping identified the challenging parts of the process which were prioritisation of the septic patient and communication of sense of urgency with the team. A simulation scenario was designed to reflect these non technical skills as core learning objectives. Data sampling was randomised to 10 patients a week after the whole patient population was examined.
9 training sessions were delivered.
A High fidelity mannequin was used
Immediate Video debrief
Real multidisciplinary teams
Identify human factors in teams
Latent risks were discovered
Results The data collected was collated into run charts showing an improvement from 12% compliance to 80% compliance in sepsis 6 and antibiotics given within 1 h and average time to first antibiotics reduced from 90 min to 22 min. run charts are available to show significant shift in practice.
Spread use of in situ simulation within quality improvement within trust
Spread to Forth Valley and Nationally
Recent national visit has requested national spread
Bring human factors training to every board in Scotland
Conclusions An in situ simulation training program as part of a quality improvement project can enable a shift in practice within a busy ED department. The aim of the project was successfully met.
- Category: Course or curriculum evaluation/innovation/integration
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