Sepsis Simulation: 3WST to the MICU at UNC Hospitals

The Code Sepsis team and a group of simulation experts at UNC Hospitals partnered on April 12 for an educational simulation focused on sepsis recognition and treatment through nurse empowerment and hands-on practice with realistic scenarios.

Sepsis Simulation: 3WST to the MICU at UNC Hospitals click to enlarge Code Sepsis
Sepsis Simulation: 3WST to the MICU at UNC Hospitals click to enlarge Physicians and nurses collaborate on a sepsis simulation involving 3WST and the MICU. The patient, called Zztest, was created in Epic@UNC.

Sepsis is a complex condition to diagnose; it can be subtle and often mimics other diseases. Sepsis education for care teams encourages increased suspicion and vigilance that can improve patient outcomes for all conditions. The Code Sepsis team is working to reduce mortality among inpatients at UNC Hospitals through quickly identifying deteriorating patients and implementing sepsis care improvement efforts including the Modified Early Warning Score (MEWS) acuity scoring system, empowerment of frontline staff, targeted Epic@UNC tools, and education.

On April 12, the team led attendees through a simulated patient case for an adult with developing sepsis, selecting 3WST as the location because general medicine floors are likely areas for sepsis cases; the care team decided together to notify the Adult Rapid Response Team (ARRT) by using a Code Sepsis Alert. A Code Sepsis Alert is initiated by calling the operator with a “Code Sepsis,” which triggers notification to the pharmacy and ARRT of a potential sepsis patient. The ARRT responded and worked with the primary physician team on initiating several interventions before transferring the simulated patient to the MICU.

Sepsis Simulation - 3WST to MICU
Pulmonology and critical care physician Dr. Tom Bice (L) reads about the simulated patient's deteriorating condition, asking participants how they would respond and testing Code Sepsis education and training.

This complex patient example mirrored sepsis cases in reality: an otherwise healthy male experienced belly pain, loss of appetite, blood in his stool, generalized weakness and lethargy, and lightheadedness. As the patient’s condition deteriorated over time, care required communication among multiple care providers, services, and levels of care. Drs. Tom Bice, Jay Lamba, Lucy Witt, and Tina Willis provided physician support to the 3WST nursing staff and ARRT nurses. The hospital operators, inpatient pharmacy, respiratory therapy, and unit support staff supported the response to this simulated critical patient. Additional physicians also responded to the simulation and participated in the team discussion.

Lucy Witt, MD, MPH, internal medicine resident physician, reiterated the importance of this educational simulation, saying, "Sepsis is a serious medical condition that can quickly become life threatening if not recognized and treated. It affects patients all over the hospital -- from the operating room to our medical geriatric patients to neonates. Early recognition of the signs and symptoms of sepsis is necessary in order to initiate appropriate fluid resuscitation and antibiosis. Everyone involved in a patient's clinical care should be trained to recognize the signs of sepsis. Our current training will help staff become more comfortable recognizing a septic patient and more knowledgeable on how to alert other members of the clinical team to their new and urgent care needs."

According to Robin Gusmann, MSN, RN-BC, clinical nurse education specialist for Acute Care Medicine & Surgery Service, hands-on sepsis educational experiences like this provide experience and build confidence in front line clinical team members.

“Sepsis education is crucial to providing staff with the knowledge to identify at-risk patients and early signs and symptoms and to activate emergency response team to improve patient outcomes,” said Gusmann. 

As the Code Sepsis team continues with the implementation of UNC Medical Center's sepsis-reduction initiative, they will hold additional simulations to educate and train UNC Medical Center health care professionals.

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