February 28, 2018

The nurse-led, 60-second screening to identify sepsis—and more ways hospitals are finding sepsis faster

Daily Briefing

    Children's Hospital of Richmond in Virginia and Harborview Medical Center in Seattle have implemented separate sepsis-detection systems that have significantly cut sepsis mortality rates.

    Reduce sepsis mortality rates with these 10 tactics

    Children's Hospital's approach: A 60-second, nurse-led screening

    Like many hospitals around the nation, Children's Hospital has seen many flu patients during this especially intense flu season—and flu can put patients at risk for sepsis, according to Jonathan Silverman, a specialist in emergency medicine at Children's Hospital.  

    "Influenza, like many viruses, can cause a temporary weakening of the immune system, putting the body at higher risk of bacterial infection, in addition to other complications caused by the virus," Silverman said. "Especially in cases of bacterial pneumonia caused by the flu, children may suffer respiratory failure or full bacterial sepsis from spread of infection, in rare cases resulting in the death of the child."

    To catch sepsis early, the hospital has implemented a mandatory, nurse-led, 60-second sepsis screening for all patients in the ED with a fever. A nurse checks each patient for abnormal vital signs, cold extremities, confusion, rashes, and a weak pulse. If the patient receives a positive score on the screening, the nurse notifies a physician, who can then provide IV antibiotics and fluids during the so-called "golden hour"—the period immediately after sepsis sets in when treatment is most effective.

    The program was implemented in early 2016, and in its first six months of implementation, it missed no cases of sepsis. Since then, only a few cases have developed in patients who scored negative on the screenings, and according to Silverman, the Children's Hospital team intervened appropriately in those instances.

    Harborview's approach: Automated alerts based on EHR data

    Harborview Medical Center, meanwhile, is utilizing patients' EHR data to determine whether they're likely to have sepsis.

    The system examines EHR data for symptoms that may be indicative of sepsis, such as high temperature, elevated heart rate, low blood pressure, and high white-blood-cell counts. If the system detects a potential case of sepsis, it alerts a nurse, who then assesses the patient further.

    According to Rosemary Grant, an RN who coordinates sepsis care at Harborview, if a nurse determines the patient may be septic, "the provider is automatically paged, out of the computer system." Physicians then respond to the patient within half an hour and aim to have the patient on antibiotics within three hours.

    If, on the other hand, a nurse determines that the patient does not have sepsis, the computer specifically asks for an alternative explanation of why the patient's vital signs are abnormal: Perhaps a patient's heart rate is simply elevated due to exercise, for instance.

    Once an alarm is triggered, the system waits 12 hours before alerting nurses again, which Grant said helps reduce the number of false alarms the staff has to handle.

    According to Grant, the system has worked well, with mortality rates dropping since the system was first installed in 2011. "Just having the nurses really being in tune with their patients is really what makes the system work," she said (Knowles, Becker's Clinical Leadership & Infection Control, 2/23; Children's Hospitals Association, 2/21; Bean, Becker's Clinical Leadership & Infection Control, 2/23; Harris, "Shots,"  NPR, 2/22).

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