Sepsis/ SIRS

Clinical Decision
Support Alerting
Cyndi Barbour, RN
NEC
November 17, 2014

Objectives
At the conclusion of this presentation, nurse
executive leaders will:
Recognize how implementation of SIRS/ Sepsis Clinical
Decision Support (CDS) alert can improve patient
outcomes
Begin to identify what operational changes may need
to be implemented to support care processes to
address and manage the CDS alert
Patient care nurse
Charge Nurse
CRT

Support the plan to educate nurses to management of

the alert

Sepsis
Sepsis is a life threatening condition that occurs
when the body responds to an infection in a
manner that injures its own tissues and organs.
Sepsis can lead to shock, multiple organ failure,
and death, especially if it is not recognized and
treated promptly.
Sepsis remains the primary cause of death from
infection despite medical advances that include
vaccines, antibiotics, and acute care; millions of
people around the world die of sepsis each year
(Buck, 2014, p.124).

SIRS
Systemic Inflammatory Response Syndrome- A
physiological response to a nonspecific insult of
either infectious or noninfectious origin
(Burdette, 2010).
Can be caused by ischemia, inflammation, trauma,
infection, or several insults combined.
Not always related to infection
Defined by changes in physiological variables

Early Identification of Sepsis

Ascension VCO (value creation opportunity)

Improve stats for early identification

Increase compliance with 3 & 6 hour care bundles
Improve clinical care : SAVE LIVES
Decrease length of stay
Improve documentation of care
Increase revenue

Seton goals:
Reduce Harm Across the Board
Reduce Serious Safety Events

Smart Interventions: Clinical Decision

Support
Sepsis
Systemic inflammatory
response in presence of
infection
Affects nearly 750,000
Americans each year
Each case extends the
patients average length
of stay by an average of
11 days, at an additional
cost of $43,000
Diagnosis and treatment in
the first golden 6 hours
can save lives

St. John Sepsis agent

Proactive risk identification
System gathers patient data,
discerns patterns
Alert fires when system finds
Two signs of systemic
inflammatory response
syndrome
One sign of organ dysfunction

Reduced mortality for severe sepsis

and septic shock from 33% to a
single-digit percentage

Reduced LOS of sepsis patients from 16.5 to

13.6 days
Sepsis Mortality rate dropped 17%
LOS reduction combined with appropriate
coding saved $ 2M

Healthe Intent: Sepsis Agent

Healthe Intent
Cloud Services

Sepsis
Agent

Chart
Search

(DAAKO
S)

Temp (SNOMED 386725007)

RR (SNOMED 86290005)
WBC (Loinc 26464-8)
Etc.

Concept
Recognition
HR
RR
Temp
BP
Labs
Status
Etc.

Cerner
Crawler

PowerChart

Cerner
Millennium

Alert, Action

Healthe
Intent

Alerting
Service

Clinical Reference Ranges

Overview of ED Workflow
Patient presents to ED
Triage Nurse triages patient: collects and
documents VS (HR, RR, BP, temp).
ED Physician may order labs, lactate
Algorithm runs, if criteria met>>
Icons display on ED tracking board
SIRS alerts RN
Sepsis alerts RN and Physician

RN notifies provider and documents on Clinical

Event Form
RN completes the task

Overview of inpatient care workflow

Patient is receiving care in an inpatient care unit
Care team documents vital signs (HR, RR, BP,
temp)
Lab values may already be present on the chart
Algorithm runs, if criteria met

SIRS and Sepsis ccons display on Care COMPASS & PAL

Tasks and Orders display
SIRS alerts any nurse with relationship to patient
Sepsis alerts any nurse with relationship to patient
Rules to prevent alert from firing again in 24/ 48 hours
from ED
Rules to prevent from firing when patient transferred
from PACU
11

Overview of inpatient care workflow

RN assesses patient
RN notifies CN
If infection is suspected, RN notifies provider, may call
CRT
RN. CN & CRT may initiate
RN completes the task by documenting on Clinical
Event Form
Process aligns with critical thinking through a PreArrest protocol or change in patient in condition

12

Example of CDS Alert

Flowsheet view
Can see history of the alert and what data
values triggered it
Menu item

Flowsheets

How often will these alerts occur?

Algorithm has been running without alerting
since June 2014.
Not going to see in WH, IMC or ICU or DCMC
Will see in the acute care units
Had alert been viewable to nurses, would have
revealed:

88 times for SIRS (3 criteria)

2 times for SIRS (4 criteria)
74 times for Sepsis (SIRS + organ dysfunction)
October 29- November 12
All adult hospitals

16

SIRS
3 SHC
3 SWC

14

3S SMC
3W SMC
4 SHC

12

4 SWC
4N SMC

10

4N SNW
4S SNW
5 SWC

5N SMC
5S SMC

6N SMC
7E BH
7N SMC

7W BH
8E BH

8W BH
9E BH
9W BH

0
3 SIRS criteria found

IMCU SHL
Med/Surg SHL

17

Sepsis
10
3 SHC

3 SWC
3S SMC

3W SMC
4 SHC

4 SWC
4E CDU BH

4N SMC
4N SNW

4S SNW
5 SWC

5N SMC
3

5S SMC
6N SMC

6S SMC
7E BH

7N SMC
7W BH

0
SIRS criteria met and Organ dysfunction criteria met

18

Education Plan
By Dec. 9, 2014
Nurses and CRT responders are to take the
Seton Learning Central (SLC) module:
seton.gradepoint.com
02NEN-CompAcuteSIRS-Sepsis
User Guides and Tips and Tricks posted on
COMPASS Clinician Sharepoint Site

19

References
Buck, K. M. (2014). Developing an Early Sepsis
Alert Program. Journal of nursing care quality,
29(2), 124-132. doi:
10.1097/NCQ.0b013e3182a98182
Burdette, S. D., Parilo, M. A., Kaplan, L. J., &
Bailey, H. (2010). Systemic inflammatory
response syndrome. Medscape, eMedicine.

20