Screening:
Technology Plan
Suggested technologies are limited to those proven to show benefit or are the only known technologies with a particular capability. Other technology options may exist or emerge after the publication of this APSS, please send information on any additional technologies, along with appropriate evidence, to
info@patientsafetymovement.org.
- Electronic Health Record (EHR)
- Web-based/EHR predictive algorithms that elicit specific data such as but not limited to vital signs (BP, Temp, HR, RR, and SpO2) lab values, nurses notes, and event reports.
- EHR serves as a data collection tool and repository for predicting risk of sepsis for patients. A system that provides a data collection tool that allows for continuous analysis and surveillance could be most beneficial.
- System must be able to identify SIRS criteria and offer clinical decision support (CDS) to healthcare professionals (such as EPIC system developed collaboratively with UCSF or Cerner implementation at Intermountain Healthcare).
- Continuous pulse oximetry:
- Adhesive pulse oximetry sensor connected with pulse oximetry technology proven to accurately measure through motion and low perfusion to avoid false alarms and detect true physiologic events, with added importance in care areas without minimal direct surveillance of patients (Masimo SET® pulse oximetry, in a standalone bedside device or integrated in one of over 100 multi-parameter bedside monitors).\cite{20098128,22626683}
- Remote monitoring and notification system
- Remote monitoring with direct clinician alert capability compatible with pulse oximetry technology compatible with recommended pulse oximetry technology (Masimo Patient Safety Net™, or comparable multi-parameter monitoring system)
- Direct clinician alert through dedicated paging systems or hospital notification system.
- Medical-grade wireless network suitable to permit reliable, continuous remote monitoring and documentation during ambulation and/or transport.
- Alternatively, a wired network can be used which allows surveillance of patients while they are in bed but not while they are ambulating.
Patient Engagement
Current strategies to reduce loss of life from sepsis focus on data collection and analysis to establish life-saving protocols. This logical starting point must evolve quickly to seek innovative ways to engage patients and families as safety partners.
Health care advocates have long supported patient education and engagement as a means to reduce the incidence of all medical events, including sepsis. A significant struggle is the public’s lack of awareness of the existence and the prevalence of sepsis, which hinders their ability to recognize and report early signs of the disease.
The public desperately needs resources to provide information and support to help them assist in efforts to screen, prevent, recognize, diagnose and to pursue evidence-based intervention and treatment. Those afflicted and their loved ones need assistance in coping during the immediate recovery period and in knowing what to expect during the oftentimes protracted post-sepsis healing process.
A foundation of information is needed in conjunction with public awareness campaigns. Helping the public develop basic skills and confidence and providing them with appropriate support both during and after a sepsis diagnosis is the key to reducing the injuries and deaths from sepsis. To achieve these goals, public involvement in the initial strategic efforts must be an integral part of developing sepsis protocols.
Sepsis Resources for the Public:
Metrics
Topic
Sepsis Mortality Rate
Rate of mortality for severe sepsis and/or septic shock patients per 1,000 patients with severe sepsis and/or septic shock
Outcome Measure Formula
Numerator: Number of inpatient mortalities for patients with severe sepsis and/or septic shock
Denominator: Total number of patients with severe sepsis and/or septic shock diagnosis codes that are admitted to the intensive care unit from the emergency department or from an acute floor setting.
*Rate is typically displayed as Mortalities/1,000 Patients
Metric Recommendations
Direct Impact: All Patients with severe sepsis and/or septic shock
Lives Spared Harm:
\(Lives\ =\ \left(Mortality\ Rate_{baseline}\ -\ Mortality\ Rate_{measurement}\right)\ x\ Patients\ _{baseline}\)
*Patientsbaseline: the total number of patients that are counted with the diagnosis of severe sepsis and/or septic shock
Notes: Patients with severe sepsis and/or septic shock are determined by the following ICD9 diagnosis codes: 995.92 (Severe Sepsis) and 785.52 (Septic Shock). Additionally, patients must be admitted to the intensive care unit from the emergency department or from an acute floor setting. If feasible, manual review of diagnosis codes is desirable due to the complex nature of sepsis.
Data Collection: Data may be pulled from electronic billing data with the above diagnosis codes. Additionally, data may be collected exclusively through manual chart review, or a hybrid method of chart review and electronic billing data.