Life After Sepsis: Post-Sepsis Syndrome Sepsis Virtual Event July - PowerPoint PPT Presentation

Life After Sepsis: Post-Sepsis Syndrome Sepsis Virtual Event July 6, 2017 12:00 – 1:00 p.m. CT 1

Mallory Bender, LCSW| Program Manager, HRET WELCOME AND INTRODUCTIONS 2

Today’s Agenda 3

WEBINAR PLATFORM QUICK REFERENCE Mute computer audio→ Today’s presentation Chat with participants Register for upcoming Download slides/resources events

How Did You Hear About Today’s Virtual Event? A) HRET HIIN flyer B) HRET HIIN website C) HRET LISTSERV D) State hospital association E) QIN-QIO F) Your organization/colleague G) Other, please specify.

6

Data Updates 7

Post-Sepsis Care Syndrome- Surviving Sepsis is Just the Beginning Elizabeth Scruth PhD MPH RN CCNS CCRN FCCM Clinical Practice Consultant Clinical Effectiveness Team- Quality Division Kaiser Permanente NCAL 8

Objectives • Describe the sequelae most common in sepsis survivors • Identify risk factors that contribute to post sepsis care syndrome 9

Background • Sepsis is an increasing burden in the USA • Sepsis management has led to decreased mortality rates • Increased number of survivors • Little known about survivors of sepsis • Sepsis survivors have increased healthcare utilization post survival • Ongoing mortality up to 2 years post sepsis Sun, et al. Critical Care Medicine. 2016: Dick, Liu, Zwanziger et al. BMC Health Services Research. 2012 10

• Sepsis survivors – increased healthcare usage in the first year • Increased 30 day readmission rates – RBC transfusion, TPN and longer duration of antibiotics ( main risk factors) – Insurance status, hospitalizations in prior year, length of stay – Study showed 50% of the readmissions – unresolved or recurrent infections Sun et al. Crit Care Med. 2016 11

• Long term care admissions and home healthcare – Two times more likely to be admitted to SNF in the five years after a sepsis admission Dick et al. BMC Health Services Research. 2012 12

Beneath Our Understanding of Sepsis 13

Sepsis and Chronic Health • Chronic conditions increase risk of sepsis • Most common infectious disease of hospitalization – pneumonia leading to severe sepsis Chronic Health Conditions  Diabetes Heart failure Cardiovascular disease  Reduced lung function-severe Cognitive impairments Chronic kidney disease Yende, Iwashyna, Angus. Trends Mol Med. 2015 14

• Severe reduction in lung function and or diabetes increases risk of pneumonia by over six fold- common cause of severe sepsis • Unmeasured subclinical changes thought to play a role – Circulating interleukin (IL)- 6, tumor necrosis factor ( TNF) and C-reactive protein ( CRP) Yende, Iwashyna, Angus., Trends Mol Med, 2015 15

The Sequelae of Sepsis • Severe sepsis/septic shock worsens – Cognitive function – Physical impairment – Chronic kidney disease – Cardiovascular disease – Sleep patterns ( Common up to one year after sepsis) May persist for several years and accelerate underlying chronic diseases Shah et al. Am J Resp Crit Care Med.2013; Wunsch et al. JAMA. 2010: Iwashyna et al. JAMA. 2010: Altman et al. Ann Amer Thorac Soc. 2017 16

• During the sepsis event the following may affect the long term recovery: – Interventions- medications, early rehabilitation – Immobilization – Delirium – Depression/anxiety – Magnitude of host immune response Shah et al. Am J Resp Crit Care Med. 2013; Kellum et al. Arch Intern Med. 2007; Wunsch et al. JAMA. 2010 17

Impaired Immune Response • Septic shock- tissue damage • Preserving organ function during sepsis- effect on chronic health- complex • Impaired immune response from sepsis- deaths up to 1 year post index event • Sepsis survivors- more susceptible to infections reducing their quality of life (herpes zoster, lower airway infections) Medzhitov et al. Science. 2012; Kellum et al. Arch Intern Med. 2007; Arens et al. Critical Care. 2016 18

Social and Environmental Factors • Both influence the development of severe sepsis and its outcomes • Race and marital status • Exposure to infection and health behaviors • Health systems and family environment – restoration of function – family involvement/equipment needed Cox et al. Intensive Care Med. 2012 19

Preventing Sequelae from Sepsis? We know how to prevent mortality-but what about mitigating morbidity in sepsis? 20

• Our actions/inactions/delays – have long-term effects on the lives of our patients 21

22

Next Steps for Patients with Post Sepsis Syndrome Suzie Fletcher BSN, RN, CMSRN Sepsis Coordinator Wesley Healthcare 23

ABOUT US Wesley Healthcare Wichita, Kansas Tertiary hospital licensed for 850 beds • Teaching Hospital • Children’s Hospital • Women’s Hospital • Over 500 babies delivered per month • Smaller 85 bed hospital (Wesley Woodlawn Hospital and ER) • 3 Emergency departments • Pediatric emergency department • 2 free standing emergency departments • 24

Post- Discharge Clinic Planning • Need for clinic 30 for days post-discharge transitional care • Health Promotion Model (Kessler, Renggli, & Swiss Centre for International Health, 2011) • Almost 20 percent of all Medicare patients are readmitted within 30 days (Alper, O’Malley, and Greenwald, 2017) • The cost of unplanned readmissions is 15 to 20 billion dollars annually (Beresford, 2011) • Reduction in readmits • Reduction in mortalities 25

Post- Discharge Clinic Planning • Resources for: Assessment of current medical status o Medication review and education o Disease management education o Focus on social environment and other non-medical issues o 26

Next Steps • Resources • Data gathering • Finance • Written Proposal • ? 27

Contact Information Suzie Fletcher BSN, RN, CMSRN Sepsis Coordinator Wesley Medical Center 550 N. Hillside Wichita, Kansas 67214 Phone: (316) 962-7007 Cell: (316) 765-2071 Fax: (316) 962-7467 28

References Alper, E., O’Malley, T.A., & Greenwald, J. (2017, April 3). Hospital discharge and readmission. Beresford, L. (2011, December). Is a post-discharge clinic in your hospital’s future? The Hospitalist Retrieved from http://www.the-hospitalist.org/hospitalist/article/124553/qi- initiatives/post-discharge-clinic-your-hospitals-future Kessler, C., Renggli, V., & Swiss Centre for International Health. (2011, March 21). Health promotion: Concepts and practices. Retrieved from https://www.google.com/search?q=swiss+center+for+international+health+health+pro motion+model&rlz=1C1GGRV_enUS751US751&oq=swiss+center+for+international+hea lth+health+promotion+model&aqs=chrome..69i57.16959j0j9&sourceid=chrome&ie=UT F-8 29

Its Not Just About Mortality Tools for Prevention & Recognition Maryanne Whitney Steve Tremain 30

• Our actions/inactions/delays – have long-term effects on the lives of our patients 31

Back to Basics • Early Recognition – Screening all ED patients at triage – Screening all seriously ill inpatient – Use BPA’s • Create action with a (+) sepsis screen – Alerts, rapid response teams 32

Decrease Morbidity & Mortality • Treat with urgency – Blood cultures and lactate – Antibiotics within the “golden hour” – Fluid 30ml/kg for patients who are hypotensive of lactate >4mmol/L • Early source identification and control 33

34

Resources http://www.sepsis.org/files/SA_Infographic1_Square3_8.5x11_PrintReady.p df 35

http://www.sepsis.org/files/sig/lifeaftersepsis.pdf 36

Open the Lines • Let’s hear from you! 37

Bring It Home Mallory Bender, Program Manager, HRET 38

THANK YOU! 39