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What PA hospitals are doing to prevent another Patty Duke

April 26, 2016 | By: Janette Bisbee

What PA hospitals are doing to prevent another Patty Duke

Hospitals are all too familiar with sepsis, the disease that killed Oscar-winning actress Patty Duke. They’ve been waging, and increasingly winning, the battle against this deadly condition.

But sepsis is still the ninth leading disease-related cause of death in the U.S. What’s more, sepsis is on the rise.

Most Americans, and even some health care professionals, don’t know enough about sepsis. As acute care providers, we need to enlist everyone in the fight.

What is sepsis?

Sepsis occurs when the body responds to infection by going into “overdrive.” Defense and immune systems go into heightened activity. This leads to widespread inflammation, poor blood flow, organ failure, and sometimes even death.

Doctors and clinicians define this worsening progression of symptoms as sepsis, severe sepsis, and septic shock.

 

Clinical criteria

Sepsis

A known or suspected infection that is causing at least two of these symptoms:

  • Fever
  • Rapid breathing
  • Elevated heart rate
  • High white blood cell count
Severe sepsis

Sepsis with failing organ function

Septic shock

Sepsis with continued low blood pressure and lack of blood circulation in tissues despite fluid resuscitation


How do you get it?

Sepsis is always triggered by an infection, either bacterial, viral, or fungal. Infections can be acquired anywhere—in the community, in your home, in the hospital, or in other health care settings.

Sepsis can begin with common infections like urinary tract infections, pneumonia, appendicitis, and skin infections. Invasive procedures such as surgery and inserting IVs and central lines can lead to sepsis.

However, sepsis also can result from a minor injury such as a cut, scrape, or burn that was not cleaned properly.

Who can get sepsis?

Sepsis affects all age groups, including the most vulnerable among us—newborn babies, small children, and the elderly. People with compromised immune systems—such as cancer patients—are most at risk. People with chronic illnesses like diabetes and kidney disease are at an increased risk. So are pregnant women and anyone who has suffered a severe physical injury.

How big a problem is sepsis?

The number of American lives lost to sepsis each year is greater than those lost to breast cancer, AIDS, and prostate cancer—combined. More people are hospitalized for sepsis than either heart attack or stroke.

From 2009 to 2014, the number of sepsis patients treated in Pennsylvania hospitals almost doubled, reaching nearly 55,000 during 2014. The U.S. Centers for Disease Control and Prevention (CDC) has documented similar trends nationwide.

In Pennsylvania during 2009, about one in five patients hospitalized with sepsis died. By 2014, hospitals had reduced that death toll to about one in ten.

Although we must do even better than that, we are making progress.

Why is sepsis on the rise?

Part of the reason behind the big rise in Pennsylvania sepsis cases may also be a key factor in the dramatic drop in mortality.

With sepsis, hospitals have learned to put a premium on early detection and rapid treatment. That’s the best way to give patents the best chance of recovery.

As we work to catch sepsis early, the number of patients diagnosed with sepsis may increase. But so do their chances for survival.

In addition to increased clinical awareness, the CDC suggests other potential reasons for increases in sepsis:

  • Growing numbers of older adults with more chronic illnesses, who are at greater risk for sepsis
  • Greater use of invasive procedures, immunosuppressive drugs, chemotherapy, and transplantation
  • Increasing microbial resistance to antibiotics

What are Pennsylvania hospitals doing about sepsis?

Hospitals across the state are putting in place practices and procedures to:

  • Recognize patients who have sepsis and might develop severe sepsis or septic shock
  • Quickly start the treatment proven to be most effective in fighting sepsis

More than 50 Pennsylvania hospitals have decided to work together to improve sepsis care. They joined the sepsis “immersion project” led by The Hospital & Healthsystem Association of Pennsylvania through its Pennsylvania Hospital Engagement Network.

Though collaborative efforts like this, Pennsylvania hospitals reduced the aggregate mortality rate for sepsis from 17.7 percent in 2009 to 11 percent in 2014 and will continue to push for lower and lower rates.

Hospitals are innovating to catch sepsis early—here’s how

Early symptoms of sepsis can be vague, so hospitals are adopting a variety of early detection techniques:

  • Sepsis screening in EDs. Emergency departments (ED) are making sure they have sepsis screening tools in their triage processes. EDs are also adopting procedures for notifying appropriate staff about any patients diagnosed with severe sepsis or sepsis shock.
  • Staff education. Educating a wide variety of staff about sepsis strengthens early detection efforts. Patients diagnosed with sepsis—but without severity or shock—who are admitted to general medical surgical units require special vigilance. Vital sign frequency and accurate reporting can be the first signs of worsening sepsis.
  • Hospital-wide, nurse-driven protocols. Giving nurses the autonomy to trigger clinical action based on sepsis screening promotes early recognition and rapid treatment.
  • Multidisciplinary sepsis committees. Doctors and nurses, EDs, intensive care units, lab and pharmacy, and quality and safety must all be on the same page about sepsis screening and treatment. Multidisciplinary teams can foster the development of protocols, policies and procedures, order sets and other electronic health record tools, and staff education needed to support early detection and rapid treatment.

With new CMS core measure, hospitals standardize rapid sepsis treatment

The importance of treating severe sepsis or septic shock quickly, and the best ways to do that, are well established. As a result, the Centers for Medicare & Medicaid Services (CMS) established a new sepsis core measure adopted from the Surviving Sepsis Campaign International Guidelines.

The new measure—officially called the Severe Sepsis/Septic Shock Early Management Bundle (SEP-1)—specifies:

  • The “bundle” of steps hospitals must take once they have identified that a patient has severe sepsis or septic shock
  • How quickly hospitals must complete those steps
 

3-hour bundle
within 3 hours of when patient meets disease criteria, clinicians must …

6-hour bundle
within 6 hours of when patient meets disease criteria, clinicians must …

Sepsis/Severe sepsis
  • Measure patients lactate levels, to determine how serious the condition is
  • Send for blood cultures
  • Start broad spectrum antibiotics
  • Start fluid resuscitation if lactate 4 or more
  • Draw another lactate if first levels were above 2
Septic shock
  • Start a 30 cc/kg IVF of normal saline
  • Start vasopressors and perform a volume status and tissue perfusion assessment (central line, ultrasound, or focused physical exam)

Hospitals must report regularly to CMS about how well they are meeting the sepsis core measure. Next year (2017), this reporting could affect hospital Medicare payments through the value-based reporting program.

In this blog, two physician leaders from a community hospital ED speak with pride about the lives they can save with the best practices outline in SEP-1. These doctors see three times more sepsis patients than those with heart attacks due to completely blocked arteries. They are excited about improving outcomes for so many of their patients.

But the doctors also caution that SEP-1 is the most complicated core measure they have ever implemented. (The CMS specifications manual is 63 pages!) Compared to previous CMS core measures that affected their ED, SEP-1 requires more communication, coordination, and teamwork.

What you can do to help win the battle against sepsis

Health care professionals of all stripes, and the general public as well, can help the most by understanding the signs of sepsis and taking immediate action if someone exhibits them.

Know the symptoms of sepsis: chills, fever, rapid breathing and heart rate, and confusion and disorientation—especially in anyone at risk due to their age, chronic illness, medical treatment, or recent injury.

The CDC’s easy way to remember sepsis symptoms

S—Shivering, fever, or feeling very cold

E—Extreme pain or general discomfort, as in “worst ever”

P—Pale or discolored skin

S—Sleepy, difficult to wake up or confused

I—“I feel like I might die”

S—Shortness of breath

If there’s any doubt, check it out. Seek immediate medical help if you think someone might have sepsis. “Wait and see” won’t work. To be treated successfully, sepsis must be diagnosed as early as possible.

If the person you are concerned about is not hospitalized or in a health care setting, you need to get them to one. There, a doctor or other clinician can make a diagnosis.

A sepsis diagnosis is a medical emergency. Handle it accordingly. Like early detection, prompt treatment is key to survival. Doctors will try to stop the infection, sustain vital organs, and prevent a dangerous drop in blood pressure.

Prevent sepsis in the first place. Encourage patients and loved ones to follow these good health habits to avoid infections and sepsis:

  • Get vaccinated against the flu and pneumonia
  • Prevent infections by thoroughly cleaning scrapes and wounds
  • Practice good hand hygiene
  • Talk to your doctor or nurse about sepsis and your concerns

Spread the word. While losing a life is always heartbreaking, Patty Duke’s recent death has propelled sepsis awareness forward. The increase in conversation and awareness can save lives and drive action, so let’s keep talking and asking questions.

For more information about the HAP PA-HEN severe sepsis and septic shock project, please contact me.

Janette Bisbee
Written by Janette Bisbee
Janette Bisbee, MSN, RN-BC, NHA, has worked in the healthcare field for over 23 years. She joined the Hospital & Healthsystem Association of Pennsylvania (HAP) in 2012, as Education/Project Manager for the Clinical Quality department, working in collaboration with member hospitals and healthsystems to reduce the incidence of hospital-acquired conditions. She also co-leads HAP’s Patient and Family Engagement and Culture of Safety initiatives. Ms. Bisbee received her Bachelor of Science in Nursing degree from Immaculata University and her Master of Science in Nursing degree from Walden University. She is also an American Nurses Credentialing Center (ANCC) board certified gerontological nurse, and holds a Pennsylvania Nursing Home Administrator (NHA) license.



Comments

Comments posted are subject to HAP’s Community Guidelines under its Terms and Conditions.

By Glen Hall   |   Sunday, November 6, 2016 9:21 PM

Excellent article. Early recognition and intervention is the key.



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