Does using a ‘Sepsis-Six’ form improve adherence to 'Sepsis Six' ?
E. Pan, S. Banik, K G Carter ([email protected])
The University of Aberdeen in conjunction with NHS Grampian
Severity subgroups: Sepsis vs Severe Sepsis
Sepsis
INTRODUCTION
• Sepsis is common & a leading cause of mortality (36%)
2,3
• Surviving Sepsis Campaign recommends
interventions to be achieved within an hour
Six’ :
‘Sepsis
6
• Audit had revealed our unit did not adhere to the sepsis 6 well
Severe Sepsis
Mortality
10.8%
12.5%
LOS (hr)
117
120
Compliance to Sepsis 6
60%
79.2%
AIMS
• Assess compliance to ‘Sepsis Six’
Form analysis: Completed forms vs No forms
• Assess compliance of ‘Sepsis Six’ form completion
• Evaluate whether completing the ‘Sepsis Six’ form improves
adherence to Sepsis-Six
METHODOLOGY
• Audit was carried out over a 5 week-period (March 2014)
Completed form
No Form
Mortality
4.3%
18.6%
LOS (hr)
105
170
78.3%
53.5%
Compliance to Sepsis 6
• Patients with a Scottish Early Warning Score (SEWS) of ≥ 3
meeting sepsis criteria1 were included
Distribution of sepsis severity relative to form
adherence
• Data was collected prospectively in terms of
(a) Form completion
(b) Compliance with ‘Sepsis Six’
(c) Duration of stay in hospital & 30/7 mortality
50
45
40
6 (14%)
18 (39%)
35
30
Severe Sepsis
25
Sepsis
RESULTS
20
37 (86%)
15
• Total Patients : 89 – (Male: 44 ; Female 45)
28 (61%)
10
5
• Sepsis 73%, Severe sepsis 27%, Septic shock: 0%
0
Form filled-in
• 52% patients had a sepsis form in place
• Mortality rate :11.2%; Median length of stay (LOS) : 5 days
Compliance to the Sepsis Six Protocol (Fig 1)
0
Full compliance
No form
CONCLUSION
• Our unit has shown a significantly better compliance to the
Sepsis Six protocol compared to audit findings elsewhere
• Form completion seemed to positively correlate with increased
compliance to the “Sepsis Six” and a subsequent reduced
mortality rate & LOS
Incomplete Compliance
66.3%
67%
33.7%
19%
Missing 1 component
Missing 2 components
3.4%
1.7%
6.9%
Missing 3 components
Missing 4 components
Missing 5 components
Compliance of Individual Components of Sepsis Six (Fig 2)
100
90
80
35.9
70
60
50
100
82
40
87.6
91
Percentage
compliance (in
patients)
82
30
52.8
20
10
0
Oxygen
Fluids
Blood cultures
Lactate
IV Antibiotics
Urine output
REFERENCES
1. Osborn TM, Nguyen HB, Rivers EP. Emergency medicine and the surviving sepsis campaign: an international approach to managing severe sepsis and septic shock. Ann Emerg Med 2005;46(3):228-231.
2 Daniels R, et al. Briefing - The UK Sepsis Trust. 10/2013; Available at: http://sepsistrust.org/wp-content/uploads/2013/10/briefing.pdf. Accessed 03/17, 2014.
3. Daniels R, Nutbeam T, McNamara G, Galvin C. The sepsis six and the severe sepsis resuscitation bundle: a prospective observational cohort study. Emergency Medicine Journal 2011 June;28(6):507-512
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