Tackling sepsis prevention, treatment: 7 tips from healthcare providers

Of all the life-threatening conditions hospitals battle on a daily basis, sepsis is a particularly fickle beast. Despite the difficulties associated with diagnosing this complication, healthcare provider organizations offered the following seven tips and tales of their sepsis detection and treatment practices.

1. Establish "code sepsis" protocols to streamline treatment.
The Maryland Patient Safety Center partnered with the Maryland Hospital Association to help 21 of its hospitals develop procedures to detect sepsis at an early stage. The initiative helped establish a coordinated team of physicians, nurses, pharmacists and phlebotomists who develop and follow protocols to respond quickly when a "code sepsis" is called by one of the nursing staff. Those protocols involve rapidly giving a patient fluids, antibiotics and diagnostic tests to confirm or deny the sepsis diagnosis and prevent a rapid escalation of the disease when present. The Center's initiative, now in its second year, was based on a program at the University of Maryland Charles Regional Medical Center in La Plata in 2012. According to Robert Imhoff, president and CEO of the Maryland Patient Safety Center, "This initiative is proving that early detection and treatment can reduce the cascade of effects from sepsis and save lives."

2. Re-evaluate the systemic inflammatory response syndrome definition for sepsis.
Amesh A. Adalja, MD, an infectious disease and critical care physician at UPMC in Pittsburgh, says, "There are several pillars of a successful sepsis management programs that hospitals can undertake. In recent years, it has become clear that aggressive recognition and treatment of sepsis is essential. While there have been well-conducted studies that show that adhering exactly to the paradigm of early-goal directed therapy is not necessary for good outcomes, having a process in place to identify and rapidly treat sepsis is important. There is also an effort underway to improve the definition of sepsis as the current SIRS plus infection definition leaves a considerable amount of sepsis patients potentially unrecognized and untreated."

3. Create systemwide workgroups and conduct weekly hospital huddles.
Jackie Blanchard, RN, director for infection prevention for Morristown, N.J.-based Atlantic Health System, says, "Atlantic Health System — which includes Morristown, Overlook, Newton and Chilton Medical Centers, all in New Jersey — [has] implemented numerous sepsis initiatives which reduced the mortality rate for patients who were present with severe sepsis or septic shock on arrival by 27 percent in the last three years. The organization has a systemwide sepsis workgroup and cutting-edge technology to assist in treating and evaluating patients' responses to treatment. Several Atlantic hospitals are involved with the New Jersey Hospital Association's Project to Reduce Sepsis Mortality or use weekly huddles to go over all recent sepsis cases to summarize successes and opportunities for improvement."

4. Consider integrating electronic sepsis alerts into clinical workflows.
Joycelyn Craighead, RN, director of quality at Huntsville (Ala.) Hospital, says "The change-management process began [at Huntsville] with the formation of sepsis-steering committees whose members were responsible for leading the sepsis program's successful development and implementation. The committees began by developing tools and establishing protocols for care and communication, including sepsis order sets and point-of-care lactate testing, which were then carried out by newly formed nursing-unit teams. Then, in 2014, we partnered with Wolters Kluwer to attempt to improve the sepsis screening and care process by integrating electronic alerting into the clinical workflow…At the conclusion of a 10-month study period, we reduced sepsis mortality by 53 percent and sepsis-related 30-day readmissions by 30 percent."

5. Don't underestimate the immune-boosting effects of probiotics.
"For people with compromised immune systems or those who have poor nutritional status or advanced age, one of the best prophylactic strategies [to prevent sepsis] is to be on long-term probiotic therapy prior to entering a hospital in the first place," says Teri Dreher, RN, owner and CEO of Chicago-based North Shore Patient Advocates. "High-quality probiotics are more effective than yogurt with active cultures in boosting immune system function and are an inexpensive way to make your body function at its peak…That said, the best strategy of all is getting patients in and out of hospitals and rehab centers as quickly as possible to avoid hospital-acquired opportunistic infections."

6. Make real-time sepsis screening a priority.
"One of the major challenges when taking care of a patient with sepsis is the early recognition component. Screening for sepsis is something that is critical in the sepsis battle, and we've been doing screening for several years at Memorial Hermann," says Laura J. Moore, MD, medical director of the Shock Trauma ICU at Memorial Hermann Hospital in Houston. "What we are using is Decisio, a clinical decision support platform that focuses on providing real-time relevant data at the point of care. By using this tool, we are able to continually screen for sepsis in real time with a screening tool that has been validated and peer-reviewed, and display that screen at the bedside for all the members of the patient care team to see. This tool alerts everyone that walks in the patient room and, if the sepsis screen is positive, we can do something about it right then."  

7. Treat sepsis as soon as possible.
Steve Okhravi, MD, founder of New York City health practice and urgent care center Emergency Medical Care, says "The only way to prevent sepsis is to recognize it early and aggressively treat it…The method I've used in emergency departments for early detection were to not wait for the results of chest X-rays or cultures to determine sepsis, but to look at fever (anything above 100.4 degrees), heart rate (above 105 beats per minute), blood pressure (systolic pressure lower than 90), oxygen saturation levels (below 95 percent) and confusion. If any of these symptoms are present, we start antibiotic treatment right away. Waiting for results from other exams could allow the body to go into shock. It's important to note that New York state mandates hospital to have an ED protocol to treat sepsis as soon as possible. I don't often agree with regulations like these but, in this case, the mandate was necessary to help save lives. The mandate provided hospitals with concrete guidelines, while still allowing each facility to modify the protocols to meet their individual needs."



More articles on sepsis:
Does NICU bed configuration affect sepsis, MRSA rates?
'We know what to do with sepsis': Ohio hospitals renew sepsis mortality reduction efforts
September is sepsis awareness month: 5 recent stories on the life-threatening condition

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