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

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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

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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

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Why This is Important…

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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

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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)

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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

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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

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How Sepsis Progresses if Untreated

Worsening infection

Systemic symptoms

Organ involvement / failure

Septic shock

Death

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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

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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

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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

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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

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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**

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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

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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)

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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.

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CDC Get Ahead of Sepsis Campaign

https://www.youtube.com/watch?v=5JvGiAFLels

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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

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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

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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

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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

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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

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2

7

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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

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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

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Laminated forms can

be posted in physician

office exam rooms for

quick reference

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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

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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

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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

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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

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Resources:

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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

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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.