Sepsis-Time is life Project and role of clinical leadership in QI

Dr Emmanuel Nsutebu – Consultant Infectious Diseases Physician Clinical lead for Sepsis

AQ Clinical Lead – Sepsis AQUA Patient Safety Fellow

Emmanuel.Nsutebu@rlbuht.nhs.uk

Objectives of the session

• How to improve recognition and management of sepsis

• Importance of clinical leadership -10 tips

What is clinical leadership?

• It is about creating conditions that make it easier for others to bring about change or do their job

• A leader is a facilitator!!!

• A sponsor for change whilst working with clinicians

• Persist in your vision but listen and adapt!

Heart & Minds

• ‘If you want to build a ship do not gather men together and assign tasks. Instead teach them the longing for the wide endless sea.’

(Saint Exupery, Little Prince)

Spend time describing the vision

Tip 1: Set a clear vision!

• Recognition and initial management was our main focus

• Adapt your organisation vision/mission

• Clinicians need to recognise the value and develop the vision

• Clinicians care about saving lives and reducing suffering – not targets!

• Adaptive change requires a case for urgency!

• SepSAS – Sepsis -Screen, Act, Save lives

• SepSIS – Sepsis -Screen, Intervene, Save lives

• Sepsis -Time is life Project!

Tip 2: Branding is important!

Tip 3: Run it like a campaign

• Involve executives and align with values/goals of the organisation

• Involve key players

• Mobilise resources

Chief executive

Senior nurses Medical Director

A 73 year old man was admitted with cellulitis via minors with no signs of sepsis. Within 1 hour, he became hypotensive with a lactate of 6 - septic shock. He was transferred to ED Resus and sepsis 6 implemented within 30 minutes. He recovered and left hospital after 5 days. Dr Nsutebu saw him in clinic in April and he was immensely grateful to the ED staff for having saved his life– he has volunteered to join our sepsis steering group as a patient rep!

Tip 4: Use patient stories………

Tip 5: Listen to staff and make the most of enthusiasm

• Sepsis cards Sepsis badges

Consider why staff may resist change?

• Listen and validate their concerns – involve them to find a solution

New ABG machines measure lactate

New sepsis 6 bundle/pathway

Tip 6: Train others to lead and organise

• You cannot do it on your own!

• Sepsis Steering Group

• A good team is unstoppable

Tip 7: Drive innovation

New simulation training Pilot of bolus administration of IV antibiotics

Blood culture packs

Tip 8: Focus on systems

Tip 9: Make the most of incidents/crisis

• Case of 54 year old lady who developed septic shock after admission to hospital

• Was not recognised and treated in a timely manner

• Used on AMU to educate staff and drive change

• Focus on early recognition and FULL implementation of the sepsis bundle

I had a full arsenal of sepsis signs and symptoms not only one but 4 consecutive doctors failed to spot it…

I did not receive antibiotics for over 15 hours

Patient’s complaint letter

17% of patients with severe sepsis received sepsis 6 within 6 hours

Audit in 2012

Where we were and what made us want to make a difference…

Most importantly -Celebrate success!

• Sepsis Newsletter

Tip 10. Use data

• Highlight the benefits: Over 12 months,

– 15% reduction in septic shock mortality

– 2830 bed days saved

– £608,450 saving

• In 2012 we completed sepsis 6 bundle in 17% of patients within 6 hours

• Advancing Quality (AQuA) data suggests that an average of 60% of patients are receiving standard care within 4 hours.

Summary

• Clinical leadership is important in QI

• Think about how you will lead QI as well as the technical aspects

• “A true leader releases passion, ingenuity and talent in people!!

Any questions? Emmanuel.Nsutebu@rlbuht.nhs.uk