Avoidable Admissions: Moving Upstream to Combat Admissions Sepsis - - PowerPoint PPT Presentation

Avoidable Admissions: Moving Upstream to Combat Admissions Sepsis Wednesday, June27th, 2018 10:00am-10:30am

This material was prepared by Telligen, the Medicare Quality Innovation Network Quality Improvement Organization, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. 11SOW- QIN-C3-08/09/18-2884

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Objectives

• Identify criteria for sepsis
• Understand the importance of early recognition and

treatment

• Identify measures to prevent sepsis
• Understand actions to take for signs of early sepsis
• Leave you with tools to use in the fight against sepsis.

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Sepsis Alliance

• Faces of Sepsis
• Patricia B.

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WHAT IS SEPSIS?

• Sepsis is the body’s extreme response to an infection.
• Sepsis happens when an infection you already have— in

your skin, lungs, urinary tract or somewhere else— triggers a chain reaction throughout your body

• S.E.P.S.I.S.

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• Mortality rates for patients with sepsis is

between 20-50%.

– Mortality rates can be reduced with early detection and treatment

– (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4502493/ pulled 2/8/18).

• Sepsis treatment cost nearly $24 billion in

2013 and these patients are 2-3 times more likely to be readmitted.

– (https://www.nigms.nih.gov/education/pages/factsheet_sepsis.aspx pulled 2/8/18).

WHAT IS SEPSIS?

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WHO’S AT RISK?

• Very young or very old
• Compromised immune system
• Having wounds or burns
• Having invasive devices
• People with chronic diseases
• People who develop sepsis often have another condition such as

pneumonia, urinary tract infections, or abdominal infections first.

• http://www.mayoclinic.org/diseases-conditions/sepsis/symptoms-

causes/dxc-20169787 pulled 2/8/18

• https://www.nigms.nih.gov/education/pages/factsheet_sepsis.aspx pulled

2/8/18

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HOW TO PREVENT SEPSIS?

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Early Sepsis Identificaiton

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Sepsis Screening

Sepsis screening q 8 hours; Evaluate the below for any NEW symptoms that have started within the last 8 hours. Suspected infection AND 2 or more SIRS criteria Suspected infection SIRS criteria Fever/chills Temp ≥100.0 or ≤96.8 Currently on antibiotics Pulse ≥100 Cough/SOB BP <100 or >40 mmHg from baseline Cellulitis/wound drainage

• Resp. rate >20/SpO2 <90%

Weakness Altered mental status

(SIRS = Systemic Inflammatory Response Syndrome)

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ACT FAST-Early Detection in LTC

• ACT FAST- for LTC
• Early detection of SEPSIS requires fast action
• Every hour a resident in septic shock doesn’t receive antibiotics, the

risk of death increases 7.6%

• Call the doctor! Prepare your SBAR before you call.
• Does the resident just not look right? Screen for sepsis and notify

the physician immediately.

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ACT FAST Tool

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Positive screen- NOTIFY ATTENDING PROVIDER IMMEDIATELY

• State “I have a patient who screened positive on the

sepsis screening tool”

• Have SBAR completed and be ready to answer questions!
• Provider to use background information and current

assessment to make clinical decisions.

• This might include:

– STAT labs and x-rays – STAT meds (including IV antibiotics and/ or IV fluids) and other treatments – Increased monitoring – more frequent assessment and vitals

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Sepsis Treatments

• Providers use a number of medications to treat

sepsis, including:

– antibiotics via IV to fight infection – vasoactive medications to increase blood pressure – insulin to stabilize blood sugar – corticosteroids to reduce inflammation – painkillers

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Sepsis Readmission Prevention

• 1. Discharge summary completed within 48 hours of discharge
• 2. Send completed discharge summary to post care provider/PCP within 48

hours of discharge

• 3. Follow-up appointment scheduled within 7 days post
• discharge with PCP and/or specialist
• 4. Discharge phone call by clinician within 48 hours
• 5. Involve pharmacy in medication reconciliation before
• discharge
• 6. Use Teach Back and Stoplight tool

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Best practices for discharged patients: HOW CAN I GET AHEAD OF SEPSIS?

• Talk to your doctor or nurse about steps you can take to prevent

infections

• Practice good hygiene
• Know the symptoms of sepsis
• ACT FAST Tool and Stoplight Tool

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STOPLIGHT TOOL at HOME

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Long term consequences of Sepsis

• Physical impairment
• Sepsis-induced inflammation and cardiovascular risk
• Sepsis-induced immunosuppression
• Long-term health-related quality of life
• Long-term mortality

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Key Points

• Prevention of sepsis is the #1 measure.
• Screening for sepsis can help identify patients early

so we can prevent hospitalization.

• Important to prioritize orders given following a

positive sepsis screen

– Don’t wait to start antibiotics – Don’t wait to get the labs, urine, x-rays, and cultures

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Questions for you

• What has worked for you in preventing sepsis?
• What barriers do you have in preventing sepsis?
• What tools are you using to detect sepsis sooner?

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Remember our challenge?

• Patricia B.
• Recognize early warning signs
• Early Identification Tool
• ACT FAST Tool
• Stoplight Tool

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Next Office Hours

• 30 minutes in length
• Third Tuesday of month at 1pm
• July 17th
• August 21st
• September 18th

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Resources

• https://www.sepsis.org/
• https://www.mnhospitals.org/Portals/0/Documents/

ptsafety/sepsis%20tool%20kit/9_Seeing%20Sepsis%2 0Act%20Fast%20Poster.pdf

• https://telligenqinqio.com/resource/signs-of-

infection-and-sepsis-at-home-stoplight-tool/

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Contact Information

• Chloe Steffensmeier
• Project Assistant

– csteffensmeier@telligen.com – Phone: 515-273-8710

• Tracy Pieters, RN
• Sr. Quality Improvement Facilitator

– tpieters@telligen.com – 515-440-8587 www.TelligenQINQIO.com