![Page 1: MSC Confidential Take the Shock Out of Sepsis. MSC Confidential Why Use Simulation?](https://reader035.vdocuments.net/reader035/viewer/2022062803/56649ce55503460f949b3347/html5/thumbnails/1.jpg)
MSC Confidential
Take the Shock Out of Sepsis
![Page 2: MSC Confidential Take the Shock Out of Sepsis. MSC Confidential Why Use Simulation?](https://reader035.vdocuments.net/reader035/viewer/2022062803/56649ce55503460f949b3347/html5/thumbnails/2.jpg)
MSC Confidential
Why Use Simulation?
![Page 3: MSC Confidential Take the Shock Out of Sepsis. MSC Confidential Why Use Simulation?](https://reader035.vdocuments.net/reader035/viewer/2022062803/56649ce55503460f949b3347/html5/thumbnails/3.jpg)
MSC Confidential 3
Simulation in Aviation
![Page 4: MSC Confidential Take the Shock Out of Sepsis. MSC Confidential Why Use Simulation?](https://reader035.vdocuments.net/reader035/viewer/2022062803/56649ce55503460f949b3347/html5/thumbnails/4.jpg)
MSC Confidential
Miracle on the Hudson
![Page 5: MSC Confidential Take the Shock Out of Sepsis. MSC Confidential Why Use Simulation?](https://reader035.vdocuments.net/reader035/viewer/2022062803/56649ce55503460f949b3347/html5/thumbnails/5.jpg)
MSC Confidential
© Medical Simulation Corporation 2009
A Changing Landscape
![Page 6: MSC Confidential Take the Shock Out of Sepsis. MSC Confidential Why Use Simulation?](https://reader035.vdocuments.net/reader035/viewer/2022062803/56649ce55503460f949b3347/html5/thumbnails/6.jpg)
MSC Confidential
On-Line Course
Didactic Review
Simulation
Debrief
Blended Learning
![Page 7: MSC Confidential Take the Shock Out of Sepsis. MSC Confidential Why Use Simulation?](https://reader035.vdocuments.net/reader035/viewer/2022062803/56649ce55503460f949b3347/html5/thumbnails/7.jpg)
MSC Confidential
Understanding the Guidelines
Standardized Metrics Individualized Feedback
Putting the Guidelines into Practice
The Application of Simulation
![Page 8: MSC Confidential Take the Shock Out of Sepsis. MSC Confidential Why Use Simulation?](https://reader035.vdocuments.net/reader035/viewer/2022062803/56649ce55503460f949b3347/html5/thumbnails/8.jpg)
MSC Confidential
MSC QI Program Components
Pre and Post course knowledge assessment & confidence survey
· 45% Increase in Confidence
· 27% Increase in Consistency of Responses
![Page 9: MSC Confidential Take the Shock Out of Sepsis. MSC Confidential Why Use Simulation?](https://reader035.vdocuments.net/reader035/viewer/2022062803/56649ce55503460f949b3347/html5/thumbnails/9.jpg)
MSC Confidential
MSC QI Program Components
•Online Course
![Page 10: MSC Confidential Take the Shock Out of Sepsis. MSC Confidential Why Use Simulation?](https://reader035.vdocuments.net/reader035/viewer/2022062803/56649ce55503460f949b3347/html5/thumbnails/10.jpg)
MSC Confidential
MSC QI Program Components
• Educator facilitated review of online content
• Educator review of hospital specific policies and procedures
![Page 11: MSC Confidential Take the Shock Out of Sepsis. MSC Confidential Why Use Simulation?](https://reader035.vdocuments.net/reader035/viewer/2022062803/56649ce55503460f949b3347/html5/thumbnails/11.jpg)
MSC Confidential
Educator-facilitated simulation & debrief: 2-4 scenarios
• Includes an element of stress and/or real patient stories
• Process and clinical elements included
MSC QI Program Components
![Page 12: MSC Confidential Take the Shock Out of Sepsis. MSC Confidential Why Use Simulation?](https://reader035.vdocuments.net/reader035/viewer/2022062803/56649ce55503460f949b3347/html5/thumbnails/12.jpg)
MSC Confidential
Metric Reports
MSC QI Program Components
63%82%
95%
![Page 13: MSC Confidential Take the Shock Out of Sepsis. MSC Confidential Why Use Simulation?](https://reader035.vdocuments.net/reader035/viewer/2022062803/56649ce55503460f949b3347/html5/thumbnails/13.jpg)
MSC Confidential
Simulation Validation
Participation in a sepsis simulation training exercise resulted in Emergency Med Residents (n=20) taking more appropriate and immediate action in administering evidence-based care to patients.7
Following simulation training, participants noted improvement in confidence levels in managing patients with severe sepsis and septic shock.8
![Page 14: MSC Confidential Take the Shock Out of Sepsis. MSC Confidential Why Use Simulation?](https://reader035.vdocuments.net/reader035/viewer/2022062803/56649ce55503460f949b3347/html5/thumbnails/14.jpg)
MSC Confidential 14
Sepsis Program Benefits
• Documentation of staff competence and compliance
• Consistent training across all staff
• Integration into hospital quality improvement
programs
• Program based on guidelines, tools and research
from: • Surviving Sepsis Campaign • Institute of Healthcare Improvement (IHI) • Latest research studies related to the treatment of sepsis
![Page 15: MSC Confidential Take the Shock Out of Sepsis. MSC Confidential Why Use Simulation?](https://reader035.vdocuments.net/reader035/viewer/2022062803/56649ce55503460f949b3347/html5/thumbnails/15.jpg)
MSC Confidential
Sepsis Program Objectives
1. DESCRIBE THE DIFFERENCE BETWEEN SEPSIS, SEVERE SEPSIS AND SEPTIC SHOCK
2. IDENTIFY SIGNS AND SYMPTOMS OF SIRS
3. DISCUSS ASSESSMENT FINDINGS CORRELATED WITH PATIENTS WHO ARE AT INCREASED RISK FOR SEPSIS (INDEX OF SUSPICION)
4. IDENTIFY SIGNS AND SYMPTOMS OF TISSUE HYPOXIA
5. IDENTIFY SIGNS AND SYMPTOMS OF ORGAN DYSFUNCTION
6. DISCUSS FLUID RESUSCITATION RECOMMENDATIONS AND GOALS ACCORDING TO THE SURVIVING SEPSIS CAMPAIGN GUIDELINES
7. IDENTIFY CORRECT EARLY IDENTIFICATION AND TREATMENT RECOMMENDATIONS ACCORDING TO THE SURVIVING SEPSIS CAMPAIGN GUIDELINES
8. DISCUSS RATIONALE FOR SEPTIC SHOCK TREATMENTS
![Page 16: MSC Confidential Take the Shock Out of Sepsis. MSC Confidential Why Use Simulation?](https://reader035.vdocuments.net/reader035/viewer/2022062803/56649ce55503460f949b3347/html5/thumbnails/16.jpg)
MSC Confidential
Epidemiology
• Sepsis is the leading cause of death for critically ill patients in the United States
• It is the tenth most common cause of death overall
• It accounts for 1-2% of all hospitalizations and for 25% of ICU bed utilization
• Projection for 2020 is 1,100,000 new cases of sepsis
![Page 17: MSC Confidential Take the Shock Out of Sepsis. MSC Confidential Why Use Simulation?](https://reader035.vdocuments.net/reader035/viewer/2022062803/56649ce55503460f949b3347/html5/thumbnails/17.jpg)
MSC Confidential 17
IHI Surviving Sepsis Process Measures
Process Measure Goals
• Timing of Blood Cultures
•Timing of Antibiotics
•Central Venous Pressure
•Central Venous Oxygen Saturation
• Low-Dose Steroid Administration
• Drotrecogin Alfa (Activated) Administration
• Glycemic Control
• Inspiratory Plateau Pressure
• Reliability
![Page 18: MSC Confidential Take the Shock Out of Sepsis. MSC Confidential Why Use Simulation?](https://reader035.vdocuments.net/reader035/viewer/2022062803/56649ce55503460f949b3347/html5/thumbnails/18.jpg)
MSC Confidential
Mortality
As sepsis progresses, mortality increases
20% for sepsis
40% for severe sepsis
Greater than 60% for septic shock
![Page 19: MSC Confidential Take the Shock Out of Sepsis. MSC Confidential Why Use Simulation?](https://reader035.vdocuments.net/reader035/viewer/2022062803/56649ce55503460f949b3347/html5/thumbnails/19.jpg)
MSC Confidential
Sepsis Audience
• Early Responders
ER
Med/Surg Nurses
• Acute Care
ICU
• Medical Staff
Residents
Fellows
• Multi-Disciplinary Team Integration
![Page 20: MSC Confidential Take the Shock Out of Sepsis. MSC Confidential Why Use Simulation?](https://reader035.vdocuments.net/reader035/viewer/2022062803/56649ce55503460f949b3347/html5/thumbnails/20.jpg)
MSC Confidential
Sepsis Continuum
SIRS
• A physiologic response of the endocrine axis and immune
systems
Sepsis • SIRS + a known or suspected infection
Severe
Sepsis• Sepsis + acute organ dysfunction
Septic
Shock• Severe sepsis + refractory hypotension
![Page 21: MSC Confidential Take the Shock Out of Sepsis. MSC Confidential Why Use Simulation?](https://reader035.vdocuments.net/reader035/viewer/2022062803/56649ce55503460f949b3347/html5/thumbnails/21.jpg)
MSC Confidential
Simulation and Sepsis
• A physiologic response of the endocrine axis and immune systems
Participants must determine if their patient meets SIRS criteria in a dynamic setting
•Is their hear rate > 90•Is their respiratory rate > 20•Do they have a temperature•Has their WBC value changed
SIRS
![Page 22: MSC Confidential Take the Shock Out of Sepsis. MSC Confidential Why Use Simulation?](https://reader035.vdocuments.net/reader035/viewer/2022062803/56649ce55503460f949b3347/html5/thumbnails/22.jpg)
MSC Confidential
Treatment
• Start Sepsis Resuscitation Bundle•Draw lactate•Draw blood cultures•Administer broad spectrum antibiotics• If hypotensive or lactate > 4 administer 20ml/kg fluid bolus over 30 min• Insert central line with ScvO2 and CVP monitoring capabilities
Simulation and Sepsis
![Page 23: MSC Confidential Take the Shock Out of Sepsis. MSC Confidential Why Use Simulation?](https://reader035.vdocuments.net/reader035/viewer/2022062803/56649ce55503460f949b3347/html5/thumbnails/23.jpg)
MSC Confidential
• SIRS + a known or suspected infection
• Participants must determine if their patient is septic
•Thorough history and physical assessment•Asking questions/hands on assessment•What is their index of suspicion
Sepsis
Simulation and Sepsis
![Page 24: MSC Confidential Take the Shock Out of Sepsis. MSC Confidential Why Use Simulation?](https://reader035.vdocuments.net/reader035/viewer/2022062803/56649ce55503460f949b3347/html5/thumbnails/24.jpg)
MSC Confidential
Treatment
• Diagnosis of source•Line insertion•Appropriate admission orders (acute care setting)•Time appropriate interventions
• Antibiotic administration• Fluid administration
Simulation and Sepsis
![Page 25: MSC Confidential Take the Shock Out of Sepsis. MSC Confidential Why Use Simulation?](https://reader035.vdocuments.net/reader035/viewer/2022062803/56649ce55503460f949b3347/html5/thumbnails/25.jpg)
MSC Confidential
Sepsis + acute organ dysfunction
• Participants must recognize indications of organ failure
•Selecting and reviewing appropriate labs•Recognizing dynamic patient condition changes through continuous assessment•Assessing CXR, Echocardiograms and other diagnostic tools
SevereSepsis
Simulation and Sepsis
![Page 26: MSC Confidential Take the Shock Out of Sepsis. MSC Confidential Why Use Simulation?](https://reader035.vdocuments.net/reader035/viewer/2022062803/56649ce55503460f949b3347/html5/thumbnails/26.jpg)
MSC Confidential
Treatment
• Appropriate interpretation of lab values• Were correct labs drawn• Recognition of organ failure
• Increased respiratory support•Decreased UOP despite adequate fluid administration•Decreasing LOC
Simulation and Sepsis
![Page 27: MSC Confidential Take the Shock Out of Sepsis. MSC Confidential Why Use Simulation?](https://reader035.vdocuments.net/reader035/viewer/2022062803/56649ce55503460f949b3347/html5/thumbnails/27.jpg)
MSC Confidential
Severe sepsis + refractory hypotension
• Participants must recognize the signs and symptoms of septic shock symptoms
•Decreasing blood pressure• Insertion of appropriate invasive monitoring lines•Use of appropriate pharmacological medications•Knowledge of the management bundle
SepticShock
Simulation and Sepsis
![Page 28: MSC Confidential Take the Shock Out of Sepsis. MSC Confidential Why Use Simulation?](https://reader035.vdocuments.net/reader035/viewer/2022062803/56649ce55503460f949b3347/html5/thumbnails/28.jpg)
MSC Confidential
Treatment
• Participants must recognize refractory hypotnesion
• Implementation of appropriate vasopressor therapy• Norepinephrine, Dopamine,
•Understanding of ScvO2 and CVP values• Inotropic support
• Dobutamine
• Implementation of the management bundle• Corticosteroid administration• rhAPC administration• Glucose control• Protective ventilation
Simulation and Sepsis
![Page 29: MSC Confidential Take the Shock Out of Sepsis. MSC Confidential Why Use Simulation?](https://reader035.vdocuments.net/reader035/viewer/2022062803/56649ce55503460f949b3347/html5/thumbnails/29.jpg)
MSC Confidential
Test Your Knowledge
SimSuite Sepsis Program Pre-Online Course Knowledge Check
Available to Laerdal SUN Attendees
and theirHospital Staff
![Page 30: MSC Confidential Take the Shock Out of Sepsis. MSC Confidential Why Use Simulation?](https://reader035.vdocuments.net/reader035/viewer/2022062803/56649ce55503460f949b3347/html5/thumbnails/30.jpg)
MSC Confidential
Conclusion
Open for discussion and question