Standardized Protocols Screen for Possible Onset of Sepsis

sepsis flyer art2Almost everyone has had a kidney infection, an ear infection or strep throat in their lifetime. Most often, the infection remains localized and patients get better.

But when the infection causes the body to mount a systemic inflammatory response, there’s considerable cause for concern. The patient has sepsis.

Though sepsis isn’t well known among everyday people, sepsis ranks as the third-leading cause of death in the U.S. after heart disease and cancer — more than 258,000 lives are lost every year. Mortality rates from sepsis rank higher than chronic lower respiratory diseases, stroke, Alzheimer’s disease, diabetes and accidental deaths, according to the website of the Sepsis Alliance (an organization dedicated to educating the public and improving outcomes for sepsis patients), which used data from the Centers for Disease Control and Prevention.

While veteran nurses and doctors have long had a sixth sense or intuition about sepsis in their patients, hospitals across the nation are taking steps to hard-wire practices aimed at enhancing recognition and treatment.

Since August, UCHealth has been working earnestly in all regions to create standardized screening tools and protocols so that any caregiver, regardless of experience level, can identify septic patients sooner, administer antibiotics quicker, and deliver fluids when necessary.

“We are trying to take a little bit of the human element out because we think we miss cases when people with varying degrees of experience treat patients,’’ said Dr. Stan Gunstream, chief quality officer for UCHealth.

The goal at UCHealth is to save 120 patient lives annually – a number Gunstream says is attainable.

“That’s the goal. It’s really straightforward: Recognize the [patient's condition] as fast as you can, give them antibiotics as fast as possible, and give them fluids when severe sepsis is present,’’ Gunstream said.

In October 2015, the Centers for Medicare and Medicaid Services will make sepsis treatment a core measure, placing a spotlight on the need for hospitals to follow standard protocols.

At Memorial, Adrienne Walsh, a clinical nurse specialist and longtime critical care nurse, is spearheading the sepsis initiative. Hired in December, Walsh has been raising awareness, educating clinicians and working with a dedicated team to develop process improvement strategies. A sepsis coordinator is also being hired to oversee all aspects of the Sepsis Quality Improvement Initiative.

“A lot of times, we don’t call it what it is. We may call it a urinary tract infection or we may call it pneumonia, but we are not calling it sepsis. And when you hear the word sepsis that should [trigger] a heightened sense of vigilance and urgency,’’ Walsh said.

Gunstream said he believes the increased awareness and education about sepsis has already improved the rate of detection, though no definitive data is yet available.

In mid-April, Memorial Hospital’s Emergency Department began an intense sepsis education rollout coupled with use of a screening tool with best practice advisories (BPAs) to recognize and provide appropriate treatment for patients. Recently, a collaborative team met for two full days at Memorial to develop an acute care-specific screening and communication tool during a Rapid Improvement Event.

The screening tool will be piloted on select med-surg units, fine-tuned and then implemented house-wide and possibly shared with other UCHealth hospitals. While the goal is to develop a universal screening tool for the system, clinicians and leadership know there may be iterations specific to regions. The tool, which will be available in Epic, will be used to assess patients every shift and as needed.

“Memorial developed this tool first, and we are anxious to see how it works, and I hope it is spread across the system,’’ Gunstream said.

Kimberly Cisneros, a process improvement consultant, has been helping guide teams in the process of developing screening and communication tools.

“We have protocols for a stroke patient,’’ said Cisneros. “When a patient is developing symptoms for a stroke, here’s who you call. We don’t have that kind of protocol for sepsis. We are trying to find a way where nurses, doctors and patient care techs can work together in a collaborative practice that is evidence-based to help identify sepsis.’’

“It’s much needed,’’ Cisneros said.

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