General Instructions1. Sign Up - to use the online quality improvement forms, you need to sign up at the Kansas Sepsis Project web site. 2. Review the charts of your hospitalized patients with infection for the past 6 months (or at least 10 patients, whichever comes first), using the supplied severe sepsis screening and tracking tools 3. Identify areas where your practice differed from the recommended practices outlined in the screening and tracking tools (at this point you can claim your first 5 CME hours) (Stage A) 4. Develop an action plan in conjunction with your interdisciplinary team to change your practice to more consistently diagnose and treat severe sepsis patients according to the evidence-based recommendations 5. Submit your action plan for review by our quality improvement and severe sepsis experts, who will work with you to refine it 6. Diagnose and treat your infected and severe sepsis patients for 6 months, using your action plan and the severe sepsis screening and tracking tools as your guide (at this point you can claim your next 5 CME hours) (Stage B) 7. Compare your practice during the 6 months of your action plan with your previous practices to determine whether your processes and/or outcomes have changed (at this point you can claim your next 5 CME hours) (Stage C) 8. If you have completed steps 1 - 7, you will receive and additional 5 hours of CME credit (total of 20 hours of credit, if you complete all 3 stages) 9. Use your most recent 6 months of patients to identify areas for further refinement in your practice (at this point you can claim 5 more CME hours) (Stage A repeat) 10. Develop a second action plan by applying the performance improvement principles and severe sepsis knowledge that you have learned in your first 6 months of participation 11. Submit your action plan for review by our quality improvement and severe sepsis experts, who will work with you to refine it 12. Implement your new action plan for an additional 6 months (at this point you can claim 5 more CME hours) (Stage B repeat) 13. Compare your practice during this second 6 months with your practices of the first 6 months to determine whether your processes and/or outcomes have changed (at this point you can claim an additional 5 CME hours) (Stage C repeat) 14. Complete the online severe sepsis practices survey to compare with the survey you took on signing up for the project 14. By completing both cycles of performance improvement work you can obtain 40 Category I CME hours in 1 year of participation - the Kansas Sepsis Project is applying to be an Approved Quality Improvement pathway for ABIM and ABFM maintenance of certification; however, the program meets all of the components and can be submitted by individuals, at present Sign Up (register)Sign Up - fill out the forms on line at the Kansas Sepsis Project web site. Read this document (pdf) that tells how to obtain CME credit for your life-saving quality improvement efforts. The following is a summary: Review Your Current Practices in Identifying and Treating Patients with Severe Sepsis 1) Review 6 months worth of hospital admissions to find at least 10 patients who were admitted for an infection or who developed infection while in the hospital. Your hospital discharge coder can help you by searching the hospital's discharge database for these infection codes. Download the pdf here, if you prefer. 2) Log in and use the severe sepsis screener to determine whether your infected patient had severe sepsis, or not. You can perform this step personally or ask an assistant to do the chart review. 3) It is important that you or your helper enter data into each form online; this will ensure that you can follow your and your hospital's progress as you continually improve your recognition and care of patients with severe sepsis. 4) For the patients who screen positive for severe sepsis, note whether you documented a diagnosis of severe sepsis in the patient's chart at the time of care. 5) For the patients who screen positive for severe sepsis, use the appropriate severe sepsis tracking tool to determine whether you took the right steps in treatment of severe sepsis, whether or not it was diagnosed at the time. Create an Action Plan for Improved Recognition and Treatment of Severe Sepsis6) While you may want to first examine the results of your chart review by yourself, it is very important that performance improvement work is carried out by an interdisciplinary team. Just as physicians need nurses, RTs, pharmacists, etc. to carry out the full care of a patient, we need them to help us improve the overall care we are providing. Likewise, hospital executives are crucial to any performance improvement effort, as they can facilitate system changes when changes are needed. We suggest that you assemble a team in your own hospital to look at current practices from every aspect and help to determine how practices can or should be changed. The AMA and the specialty boards actually require that this systems-based process is interdisciplinary, in order for you to receive CME and maintenance of certification credit. Successfully improving care by a team effort builds morale and is contagious. 7) Once you've determined areas of your recognition and treatment of patients with severe sepsis that can use improvement, write down a specific plan for changing those aspects of your practice. The development of this plan will involve yourself, in conjunction with physicians, nurses, and hospital executives (an inter-disciplinary team) who can influence your hospital's portion of the work, i.e. your plan should be developed by a multidisciplinary team. A plan should include small tests of change, rather than attempting to correct every problem you find, all at one time. The Institute for Healthcare Improvement is an excellent source for information on performance improvement that is generalizable to every aspect of your practice. 8) After you develop your plan you will need to have it reviewed by an expert in sepsis and in quality improvement. For this project that will mean that you can send your plan to the KU Department of Continuing Education. Attach your plan to the email as a Word document. We will review your plan and help you to understand what parts of it may need adjustment, so that it is workable. We want you to be successful, so we will work with you until your plan is simple enough, yet powerful enough to help you change your practice. Implement Your Plan for Improved Recognition and Treatment of Severe Sepsis9) Some plans for quality improvement are well enough conceived and designed that they come off without a hitch. Those are rare. For the rest of our plans we must be adaptable and change our approach as circumstances dictate. However, if we have the goal of improving the quality of the care we provide, it is wise to make small changes in our plan in a structured, organized way and to monitor whether the change produces the result we desire before we jump into it with both feet. This activity is referred to as either "small tests of change" or "PDSA cycles". "PDSA" is an acronym for "Plan", "Do", "Study", "Act". In planning the small test there are two important questions we ask ourselves: "What is it I am trying to accomplish?" and "How will I know that I am successful?" For those who have participated in scientific research, this will be very much like the hypothesis testing that takes place in a clinical research project or in the laboratory. In our plan we project or hypothesize about what result we expect when we make the change, and we decide on a way to determine whether that result was achieved. Then we implement the change on a small scale, i.e. for 2 to 5 patients or charts. We study our results to determine whether the change is understandable, feasible, doable, and results in the outcome we desire. We then act by incorporating the change (or not) into our day to day activity and by determining other areas of our process that need changed. The Institute for Healthcare Improvement has good information on the use of PDSA cycles in quality improvement. The Kansas Sepsis Project leaders are experts and can help at any time; please email Dr. Steve Simpson to discuss your PDSA process and to set up a time for a web meeting or phone conversation. These are called cycles, because outcomes, especially in a disease like severe sepsis are never perfect, but we repeat the process over and over so that we can continuously move in that direction and improve continually. Review Your Experience and Data for the Six Month Period10) At the end of six months of identifying and treating patients with severe sepsis, stop to compare your current practices with your practices at the beginning of your project. Ask yourself which changes seemed to accrue the greatest benefits for your patients. Think of ways that you can enhance those improvements to maximally leverage the benefit for your patients. Use your new practice as a baseline for further improvement. |
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