CBERT Committee – Sepsis Program Developed Process for Sepsis Screening utilizing the Modified Early Warning Score (MEWS > 4)  Pilot completed (2 week durations) 1. MEWS / Sepsis pilot,  2 Med-Surg areas, 2 PCU areas  If a MEWS >4, then:    mandatory ERT alert, Sepsis screen Stat Nursing team Scripted assessment for sepsis with escalation through Medical Team when Positive for SIRS/SEPSIS Pilot Goal:  Early Identification of Sepsis  Implement the Sepsis Bundle (protocol)  Initiate antibiotic therapy within 1hr MEWS/Sepsis Pilot - Outcomes  Call volumes did increase 1.8/d - 9.0/d  Sustainability for process as defined - ?  Sepsis cases  Increased suspicion of Sepsis during pilot period was noted  Pre-pilot 35.3% vs Pilot 78.6%  Increased dialogue between STAT teams & MD groups     Post pilot more lactates now ordered Bedside RN increased awareness of MEWS scores MEWS catches sepsis “not a lot of false alarms” Early interventions/support given to patients without a sepsis concern Lessons Learned  ERT alert fatigue concerns for the primary MD teams  Consider silent ERT/Stat Nursing consult or Sepsis Alert vs the pilot process (ERT alerts for MEWS>4)  Lack of process/algorithm  Develop an order set w/sepsis identification  Define exclusion criteria  Improved education to all teams  Need for Lactate  Fluids not ordered unless hypotensive Next Steps  Sepsis workgroup:  “New” PI project sepsis surveillance  Sepsis screen by bedside RN  ALL MEWS >4 or > 50% change  (+) sepsis - ISBAR RN to covering MD  Documentation for ABX, lactate, or IVFs queries and/or actions  2nd Sepsis Screen pilot: 1st Quarter FY16  “New” CMS Sepsis Bundle – October 2015  Severe sepsis/septic shock