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150 Lives in 150 Days / Start: September 2013
Accelerating the spread of evidence-based sepsis protocols.
This campaign launched by The British Columbia Patient Safety and Quality Council (BCPSQC), with support of the BC Sepsis Network, aims to increase the use of sepsis protocols to treat clients with severe sepsis or septic shock in Emer- gency Departments by a clinician lead movement.

Goal of the program:
To save 150 Lives in 150 Days by spreading the use of evidence based sepsis protocols to treat clients with severe sepsis or septic shock in Emergency Departments in British Columbia, Canada.

Target group:
Clinicians practicing Emergency Medicine in British Columbia.

Legal Structure:
This campaign was launched by the British Columbia Patient Safety and Quality Council (@BCPSQC).

Organizational Structure:
The BCPSQC supports clinical improvement for healthcare focused on a number of different topics within a Ministry of Health initiative called Clinical Care Management. The treatment of sepsis is one such priority. The team dedicated to improving care for sepsis provincially includes:
Sepsis Clinical Lead: Dr. Dave Sweet
Sepsis Quality Lead: Meher Shergill
Sepsis Clinical Expert Group: 12 members represented by clinicians and BC Ministry of Health
Director of Clinical Improvement: Shari McKeown
Executive Director of the BCPSQC: Christina Krause
The BC Sepsis Network: @BCSepsis, a community of practice of clinicians passionate about improving the treatment of and decreasing the mortality due to sepsis. Their vision is to deliver
‘Best Care, No Matter Where.’

Resources are provided by the BCPSQC.

Financed by:
Financed by governmental program: 100%

Description of the program:
The BC Sepsis Guidelines outline protocols for treating severe sepsis and septic shock based on the best practice algorithms of Early Goal Directed Therapy. 1 These evidence-informed guidelines were distributed widely across BC, with implementation and change management supported by BCPSQC and the BC Sepsis Network. To spread awareness and use of sepsis protocols within Emergency Departments, the BCPSQC launched a voluntary, clinician-lead, action focused campaign - To Save 150 Lives in 150 Days!
Why 150 Lives?
For severe sepsis and septic shock every five patients treated with a sepsis protocol saves 1 life. 2 This is based on the ‘Number Needed to Treat’ (NNT) ratio for severe sepsis and septic shock protocols. 2 If all participating Emergency Departments treat 750 patients in total with a sepsis protocol, in 150 days, the goal of saving 150 Lives is achieved.

How do teams participate?
Each Emergency Department (ED) is voluntarily signed up by a clinician identifying as a 150 Lives Team Lead. Once registered, the team can begin entering their sepsis cases online. Every time they care for a client with severe sepsis or septic shock, they are asked to:
1. Go to BCSepsis.ca/150Lives. Click Enter Your Sepsis Case.
2. Click to indicate if the patient’s lactate was ≥ 4mmol/L, or if the systolic blood pressure was < 90mmHg, and if a sepsis protocol was used
3. Enter the clinician name, hospital, and click submit.
4. Enter the sepsis case in the Box Full of Lives
Each team is requested to enter a sepsis case online, and in a Box Full of Lives – this is a physical box located in each participating ED. The clinician is requested to write their name on a patient label and slip it into the box. To ensure a sepsis case is not double counted, the entries in each site’s Box Full of Lives is cross-referenced with the online entries.

Promoting sepsis protocols and 150 Lives
Sites were provided with resources to take part in the campaign, including; 150 Lives posters, How to Save 150 Lives guides; a label for the Box Full of Lives and the BC Sepsis Guidelines outlining sepsis protocols.

Team Leads and the BC Sepsis Network were regularly updated on 150 Lives progress through the website, e-newsletters and social media. The Quality and Clinical Lead for sepsis connected individually and collaboratively with Team Leads by web-conferences to discuss success and barriers to running 150 Lives and adopting sepsis protocols.

To support clinicians in adopting the BC Sepsis Guidelines, an e-learning module on Identification and Treatment of Sepsis; an educational video showcasing local clinicians; and a partnership collaboration with Read by QxMD (a medical journal app for knowledge translation), were launched during the 150 Lives campaign.

Key Features:
• Clinicians in Emergency Departments (ED) across BC now have experience in taking collective action for change
• Focus on shared values and voluntary participation
• Created a sense of urgency to initiate change and sustain motivation - 150 Lives to save in 150 Days.
• The model of distributed leadership was used to spread innovation - 150 Lives identified and supported emerging and improvement focused leaders.
• Social capital used to sustain change - 150 Lives built and strengthened ties within the network of ED clinicians.
• Social media used to develop a community - 150 Lives used Twitter, webinars, e-mail and the website to communicate frequently with clinicians individually and collectively.
• Gamification principles were used to promote clinician engagement. Participants could download the 150 Lives entry form as an app on their mobile device, and every severe sepsis/septic shock protocol used counted towards the total number of lives saved per site and provincially. A digital clock counted up the number of lives saved and the days remaining in the campaign.

Next Steps:
• Sustaining the energy: 28 Lives to save, 25 days to go!
• Evaluation of 150 Lives by quantitative and qualitative methods (network mapping)
• Quality Improvement for Sepsis protocols: To build on the energy created by 150 Lives and focus on quality improvement - To measure, monitor and improve performance goals related to the appropriateness of care.

• Sustaining commitment of clinicians who have competing clinical priorities
• Balancing the frequency and tone of communication so the initiative is not drowned within the sea of digital and administrative noise

Lessons learned:
• Communicate frequently and strategically
• Positive affirmation works
• Local champions and regional connections are key
• Collective responsibility can be an ally
• Frequent feedback of results is effective in accelerating change

BC Sepsis Network: 150 lives
1. The BC Sepsis Guidelines
2. Rivers, EP. Point: Adherence to Early Goal-Directed Therapy: Does it really matter? Yes. After a decade, the scientific proof speaks for itself. Chest.2010: 138:476-480
Over the past year we've been collecting the questions we receive most frequently about sepsis. Please share this information with your friends and family. Don’t see your question on the list? Get in touch with us, and we’ll do our best to help.
UK Sepsis Trust national sepsis campaign
The UK Sepsis Trust achieved governmental engagement with the establishment of a cross parliamentary group.
Latin America Sepsis Institute (LASI)
Implementation of sepsis protocols
A single point of information for sepsis programs
We want to create a single point of information for all those great events and campaigns around the world …
Sepsis Facts
Sepsis is common and often deadly. It remains the primary cause of death from infection, despite advances in modern medicine like vaccines, antibiotics, and intensive care.