Taming Sepsis: Simulation-Based Educational Program

Purpose: The purpose of the Taming Sepsis Education Program® was to assist nurses in the early identification and prompt treatment of patients in the sepsis continuum. The multimodal design utilized online learning and replicated scenarios using human patient simulators affording the application of evidence based practices.

The overall program goals of TSEP™ were to:

1. Decrease the mortality rate of patients with severe sepsis and septic shock
2. Implement evidence-based sepsis bundles throughout the North Shore-LIJ Health System (NSLIJ) hospitals
3. Utilize simulation as an integral part of a comprehensive educational program designed to instruct clinical staff in early identification and prompt treatment of sepsis

Methods:

TSEP™ is innovative both as a strategic initiative for implementing sepsis bundles and as an educational curriculum designed to improve patient care for patients on the sepsis continuum. NSLIJ launched a multi-faceted, interprofessional effort to promote and monitor the evidence-based guidelines embodied in the sepsis bundles.

TSEP™ is comprised of an innovative curriculum that integrates human patient simulation, elearning about sepsis management, and a variety of essential supplemental skills.  Simulation forms the core of TSEP™.  Nurses participate in two scenarios and educator-lead debriefs enabling a team of clinicians to practice recognizing and treating sepsis. The simulation component of TSEP™ is held at the Patient Safety Institute, which is the simulation center for the health system and is located geographically close to the health system’s largest hospitals. Emergency medicine and family practice physicians have participated in the simulation scenarios, which adds to the realism and has enhanced interprofessional learning.

Engaging in simulation enables clinicians to apply the evidence-based guidelines they previously learned in the online modules.  The didactic materials and simulation scenarios are based on case studies developed by an interprofessional team of NSLIJ clinicians. The module structure enables the team to revise the TSEP™ educational modules to meet the particular needs of different nursing specialties.  

TSEP™ enriches and expands nurses’ knowledge through four additional online modules. First, the health system president and CEO introduces TSEP™ and emphasizes that it is a system-wide strategic priority to treat sepsis effectively and improve patient outcomes.  The second module explains IHI’s concept of “bundles” (i.e., a set of evidence-based guidelines). The third module reviews TeamSTEPPS^® (communication model), and the fourth discusses cultural awareness and health literacy.

The educational program includes an assessment of participants’ knowledge and clinical practice. Participants completed a knowledge assessment before and after completing each module and are required to receive a score of 80% or higher on each post-assessment.  Simulation educators used a checklist to evaluate each team’s clinical performance, including identifying triage level, recognizing stages of sepsis, verbalizing the correct diagnosis, and enacting the correct treatment. Participant evaluations were used to evaluate TSEP™ based on three levels of the Kirkpatrick model.

Results:

Since 2012, over 2500 clinicians have engaged in TSEP’s evidence-based sepsis recognition and treatment curriculum. NSLIJ achieved a 50% reduction in sepsis mortality rate from 2009 to 2014. In 2013, NSLIJ’s 17 hospital emergency departments (ED) collectively reported improvement in four key sepsis bundle elements (n=600 sepsis cases monthly). NSLIJ’s sepsis initiative, combining TSEP™ and improvement science methodologies, contributed to these dramatic improvements in patient outcomes and clinical practice. Pre/post assessment scores for all modules indicated statistically significant improvements. The clinical performance checklist demonstrated participants’ practical application of knowledge in simulation.  Evaluations used to evaluate TSEP based on three levels of the Kirkpatrick model indicated that learners self-reported simulation as an effective tool to solidify information and that the sepsis education in TSEP™ was presented in an easily understood manner.

NSLIJ recognizes the patient safety and educational value of TSEP™. All newly-hired nurses across the NSLIJ Health System are required to complete TSEP™ as part of their orientation.

Conclusion:

The model of knowledge in action that is demonstrated by TSEP™ is effective in creating measurable results. NSLIJ achieved a 50% reduction in sepsis mortality rate from 2009 to 2014. Pre/post assessment scores for all modules indicated statistically significant improvements. The clinical performance checklist demonstrated participants’ practical application of knowledge in simulation. NSLIJ’s ED's showed improvement in four sepsis bundle elements. Evaluations used to evaluate TSEP indicated that learners self-reported improved confidence and competence in the treatment of patients in the sepsis continuum. Other benefits of TSEP™ are that the modules are hosted on a learning management system, and can be accessed by clinicians throughout the organization at anytime. The TSEP™ educational modules were developed collaboratively by an interprofessional group of clinicians, making TSEP™ easily modifiable to meet the needs of additional clinical specialties and changing evidence-based data. Additionally, TSEP™ fulfills the New York State Department of Health Law 405.4 requirements for sepsis education.