Post on 18-Mar-2020
Community Based Sepsis
Awareness
NYSARSC Annual Conference
June 7th
, 2018
Eve Bankert, MT (ASCP)
IPRO Senior Quality Improvement Specialist
Presentation Outline
Sepsis definition
Sepsis Alliance video: “Sepsis: Emergency”
Infection and sepsis
High risk populations
Symptoms and progression
Treatment strategies
Preventative measures
CDC video: “Get Ahead of Sepsis” campaign
IPRO Community Based Sepsis Awareness Initiative
Care coordination tools
2
Sepsis
3
Sepsis is a life threatening condition that arises
when the body’s response to an infection
injures its own tissues and organs1
The term used to describe when infections get out of control
and cause the body to shut down
Sepsis is a leading cause of death and healthcare
spending globally 2,3
1. Singer, et al. JAMA 2016;315(8) 801-810
2. Fleischmann, et al. Am J Resp Crit Care Med. 2016; 193:259-272
3. Iwashyna, et al. J Am Geriatr Soc. 2012;60:1070-1077
Why Community Based?
> 80% of sepsis cases originate in the community
Sepsis mortality is largely preventable with early detection
and appropriate treatment
Just 58% of U.S. adults have heard of sepsis
Sepsis diagnosis is sometimes missed by healthcare
providers
In NYS, sepsis treatment protocols and provider education
focused on ED and Critical Care Units
4
42% of Americans Have Never Heard of Sepsis
1.http://www.sepsisalliance.org/news/2013/four
_in_ten_adults_never_heard_of_sepsis
Why Haven’t I Heard of Sepsis?
If someone died of infection they likely had SEPSIS
You may have heard of people dying of:
Pneumonia
Abdominal Infections
Kidney Infections
Blood Poisoning
6
Why This is Important…
7
About Sepsis Alliance: Sepsis Alliance was created to raise sepsis awareness among both the general public and healthcare
professionals. Sepsis awareness can and does save lives, yet only 58% of American adults have ever
heard the word. Sepsis Alliance gives a voice to the millions of people who have been touched by
sepsis – to the survivors, and the friends and family members of those who have survived or who have
died.
View on Sepsis Alliance Website: http://www.sepsis.org
Sepsis: Emergency video
8
https://www.youtube.com/watch?v=DnsQ4RlXsZY
Famous People Who Have Died From Sepsis
Pope John Paul II
Patty Duke (actor)
Christopher Reeve (actor)
Mohammed Ali (boxer)
Jim Henson (Muppets
creator)
Casey Kasem (radio
personality)
Chuck Brown (singer)
Marty Allen (comedian)
Robin Gibb (singer)
Lawrence Welk (musician)
Anna Nicole Smith (model)
9
Who is at Risk for Sepsis?
Anyone with an infection!
Those at higher risk for developing sepsis include:
People 65 or older
Infants less than 1 year old
People with chronic illnesses: diabetes, cancer, AIDS
People with weakened immune systems
People recently hospitalized
People recovering from surgery
People who have had sepsis in the past
10
Common Infectious Diseases That May
Progress to Sepsis
Pneumonia
Skin Infections (cellulitis)
Urinary Tract Infections
Intra-abdominal infections
Influenza
Post-partum Endometritis
Clostridium difficile (C.diff) Enteritis
Tick Borne Infections especially in the immunocompromised
11
How Sepsis Progresses if Untreated
Worsening infection
Systemic symptoms
Organ involvement / failure
Septic shock
Death
12
Sepsis and Infection
Sepsis is always triggered by an infection
Sepsis can arise from something as innocuous as a
scrape or cut that gets infected or as obvious as
pneumonia or a UTI
Sometimes people don’t know they have an infection
Sepsis diagnosis is sometimes missed due to varying symptoms
*7 out of 10 sepsis patients had recently interacted with a
healthcare provider
Conversely: If symptoms of sepsis exist a source of infection
should be sought
13
Symptoms of Severe Infection
Sepsis Develops from Infection
Recognizing the signs of severe or worsening infections is
important
Look for a combination of symptoms:
Fever, shivering or feeling very cold
Clammy or sweaty skin
Confusion
Rapid heart rate
Problems breathing
Extreme pain/ discomfort
14
How Sepsis Develops
Systemic Inflammatory Response Syndrome (SIRS)
SIRS is non-specific caused by: infection, inflammation, or trauma
SEPSIS = INFECTION + 2 OR MORE SIRS CRITERIA
SIRS Criteria:
Fever >101°F
Hypothermia <96.8°F
Heart rate >90 beats/minute
Respiratory rate >20 breaths/minute
WBC >12 or <4 or >10% bands
Note: SIRS can exist without progressing to Sepsis
15
Progression of Stages of Sepsis
If not treated promptly, Sepsis can progress!
Infection (suspect or confirmed) + 2 or more SIRS criteria
SEPSIS
Sepsis + new onset organ dysfunction
SEVERE SEPSIS
Severe Sepsis + hypotension not responding to drugs
SEPTIC SHOCK
16
Treatment for Sepsis
Sepsis is usually treated in the hospital with:
Prompt administration of IV
antibiotics
Prompt IV fluid administration
**Sepsis treated in the early stages results in better outcomes
and reduced risk of long term complications**
17
Time to Treatment is Critical
• Sepsis deaths increase by 8% for every hour that
appropriate treatment is delayed
• Early identification and treatment are the keys to
improved outcomes
• Most sepsis related hospital deaths occur within the first
5 days
18
2016 Proposed New Definitions for Sepsis
Third International Consensus Definitions for Sepsis and Septic
Shock (Singer, et al. JAMA 2016;315(8) 801-810)
Utilizes SOFA criteria: Sequential Organ Failure Assessment score
qSOFA (quick SOFA) Criteria:
Better predictor of patient outcomes for non-hospital and non-ICU
settings (vs. SIRS criteria)
Appropriate and easy to use in the outpatient setting
2 of the 3 criteria provides simple bedside criteria to identify adults
with suspected infection who are likely to have poor outcomes
Altered mental status
Hypotension ( systolic <100mmHg)
Increased respiration rate (>22 breaths per minute)
19
Relevance to Service Coordinators
Reasons for engaging service coordinators in sepsis
education:
Service coordinators’ position make them an important player in the
sepsis effort
Service coordinators are in homes and in communities.
Accessing and facilitating needed services, service coordinators
help residents “age in place” healthfully in independent housing
for as long as possible
Service coordinators are: educators, screeners, evaluators,
interveners, and system navigators.
Home and community is the growing and future environment of
care.
20
CDC Get Ahead of Sepsis Campaign
https://www.youtube.com/watch?v=5JvGiAFLels
21
IPRO Community Based Sepsis Project
Objectives
Educate on the premise that Sepsis is a Medical Emergency
with the understanding that the majority of cases originate in
the community
Reduce sepsis related morbidity and mortality in designated target
regions: Albany and Syracuse
Hospital Referral Regions
Decrease sepsis related hospital readmissions
Facilitate sepsis education for pre-hospital providers using a Train-the-
Trainer format
Increase early recognition of sepsis at the community level
Highlight role physician in care coordination
22
Patients Hospitalized for Sepsis
Are more severely ill than those hospitalized for other
conditions
Have considerably longer lengths of stay in the hospital
than those hospitalized for other conditions (median=10
days)1
Are more likely to die during hospitalization compared to
those hospitalized for other conditions
23
1. MMWR Vol.65 Aug.2016
Post Sepsis Syndrome
Affects up to 50% of sepsis survivors
Post-sepsis syndrome is a condition that can result in physical
and/or psychological long-term effects, such as:
Amputations
Impaired cognitive function
Mobility impairments
Hallucinations
Loss of self-esteem
Increased dependency on others
Significant Impact on Caregivers
Inadequate hospital discharge education on what to expect during recovery
Difficulty accessing follow-up community treatment
Cost
Disruption to their lives
24
Antibiotic Stewardship vs. Treating Sepsis
Not a Conflict in Strategies!
Stressed in all Training and Community
Outreach Events
Urgent antibiotic therapy is needed for bacterial infections to prevent
progression to sepsis and septic shock
Growing focus on appropriate use of all antibiotics both in and out of
the hospital
Discourage empiric prescribing for upper respiratory tract infections
and non-specific febrile and viral syndromes
Reserving antibiotics for conditions such as sepsis is vital in
positively impacting the drug resistant bacteria issue
25
Care Coordination Tools
Home Care Association of NYS Adult Sepsis
Screening Tool
Sepsis Zone Tool
Quick Reference Tool for Clinicians
Pre/Post Learning Assessment
Informational Brochures
26
2
7
28
Crosswalks to mandatory NYS Emergency
Department Sepsis Protocol
Already included in Vital Signs
and Nursing Assessment
Patient w infection
but no systemic
symptoms:
provide pt. with
self assessment
(Zone) tool
Sepsis Zone Tool
29
Patient information sheet to
self-monitor for the early
signs and symptoms of
sepsis
For patients that have either
been diagnosed with an
infection or are at high risk
for developing an infection
Available in English and Spanish
Quick Reference for Clinicians
30
Laminated forms can
be posted in physician
office exam rooms for
quick reference
31
Pre and Post
Training
Assessment to
measure increase
in learning
AQIN Sepsis Brochure for
Community Based Education
Available in English and
Spanish
Prompt antibiotic
administration for
sepsis/suspected sepsis
and antibiotic
stewardship are not
conflicting strategies
Simple measures you can take:
Practice good hand hygiene
Avoid infections whenever possible
Treat infections promptly
Get vaccinated!
Maintain good overall health
Know the early signs of sepsis
34
Preventative Measures
New York State Regulations
2013: Governor Cuomo passes mandatory sepsis protocols for all New
York hospitals1 “Rory’s Regulations”
Developed by the Rory Staunton Foundation, Northwell Health and the
NYS Department of Health
Requires all NYS Article 28 hospitals to adopt evidence-based protocols:
Early recognition and treatment of sepsis
Staff training
Collection of patient data for analysis by NYS DOH
35
1. NYS Department of Health Sepsis Regulations: Guidance Document 405.4 (a)(4). 2013.
According to the NYS DOH: Rory’s Regulations saved >5,000 lives 26
mos. after implementation,
Illinois and NJ subsequently adopted sepsis protocols
The goal of the Foundation is to ensure that all states adopt protocols by
2020
The Rory Staunton Foundation
Founded by Ciaran and Orlaith Staunton following the death of their
12-year-old-son Rory in 2012
Dedicated to improving sepsis awareness, diagnosis and treatment
through:
Public awareness
Sepsis education for school children, parents and school personnel
Development of mandatory sepsis protocols in hospitals
National Family Council on Sepsis: Provides a platform for voices
of sepsis survivors and those having lost loved ones to sepsis
through the
36
Webinar for Physicians
“Early Recognition of Sepsis in Outpatient Setting: The
Role of Practitioner, Patient and Family in the Earliest
Phase of Sepsis”
Presented by Dr. Alan Sanders / President and Partner of Upstate Infectious
Diseases Associates, LLP
http://qualitynet.webex.com/qualitynet/playback.php?First=No&FileName=
http://webmedia.ipro.org/AQIN/F-NYOUTPATIENT061616.wrf
Also found in the Webinar section on our Sepsis Page at
stopsepsisnow.org
37
Resources:
38
CDC “Get Ahead of Sepsis Campaign”:
https://www.cdc.gov/sepsis/get-ahead-of-sepsis/index.html
Sepsis Alliance:
http://www.sepsis.org/
Rory Staunton Foundation:
https://rorystauntonfoundationforsepsis.org/
IPRO Sepsis Initiative
http://stopsepsisnow.org
Surviving Sepsis Campaign:
http://www.survivingsepsis.org/Pages/default.aspx
Questions
Comments
39
To Obtain Training Materials Contact:
IPRO REGIONAL OFFICE
20 Corporate Woods Boulevard
Albany, NY 12211-2370
www.atlanticquality.org
Sara Butterfield, RN, BSN, CPHQ
Senior Director
(518) 320-3504
Sara.Butterfield@area-I.hcqis.org
This material was prepared by the Atlantic Quality Innovation Network/IPRO, the Medicare Quality Innovation Network Quality Improvement Organization for New York State, South Carolina, and the District of Columbia, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents do not necessarily reflect CMS policy. 11SOW-AQINNY-TskSIP-Sepsis-16-07
Eve Bankert, MT (ASCP)
Senior Quality Improvement
Specialist
(518) 320-3552
Eve.Bankert@area-I.hcqis.org
IPRO Sepsis Initiative
http://stopsepsisnow.org
This resource is not all inclusive and may not apply to all patients/residents and/or situations. It is intended for educational purposes only and as guidance to support investigation for performance improvement, not as a substitute for treatment or advice from a physician or healthcare provider. IPRO does not endorse any particular vendor or tools.