See It, Treat It, Defeat It: Brigham Health task force takes on sepsis

Sepsis has a mortality rate of 26 to 50 percent and remains the leading cause of death in U.S. hospitals. Multiple studies have shown that early sepsis detection and treatment are associated with decreased mortality. In an effort to improve outcomes for our patients, Brigham Health has formed an interdisciplinary Sepsis Task Force to improve sepsis care for all Brigham Health patients. These efforts include best practice alerts, educational roll-outs and order sets as well as sepsis screening. At Brigham and Women’s Faulkner Hospital, this increased attention to sepsis will not only save lives, but also help us to adhere to recent Centers for Medicare and Medicaid Services (CMS) requirements regarding the collection and public reporting of early sepsis management data. 

With the death of actress Patty Duke from sepsis, the media has turned its attention to the topic. It’s been suggested that rates of sepsis are on the rise. However, Surgical Quality Manager Alexandra Koffman, MSN, RN, who is one of the representatives to Brigham Health’s Sepsis Task Force from BWFH, says this has more to do with CMS recently changing its definition of sepsis. She also explains, with the change from ICD-9 to ICD-10, coding for sepsis has also changed. “I don’t think there is more sepsis,” she says. “I just think we are coding more for sepsis.”

Sepsis is a complication of infection. A patient becomes septic when chemicals released into the bloodstream to fight infection trigger inflammatory responses throughout the body. Inflammation can then trigger other changes that may damage organ systems, even causing them to fail. When caught early, sepsis can often be treated successfully with antibiotics and large amounts of intravenous fluids, but recognizing sepsis in the early stages is often difficult.

“We’ve identified sepsis as a killer among patients,” says BWFH ICU Nurse Director Pat Marinelli, MSN, RN, NP, who also sits on Brigham Health’s Sepsis Task Force. “It’s oftentimes under detected and by the time you do detect it, you are well into the process. If you had intervened earlier you might have saved the patient anguish and even their life.”

Early detection of sepsis is something Marinelli and her ICU staff have worked with the ED to improve in recent years. “In 2013 we developed an algorithm and treatment plan for septic patients that began in the Emergency Department and followed through to the ICU,” says Marinelli. When patients present with certain symptoms such as not feeling well, or exhibit a change in mental status, feeling weak, fever, elevated white blood cell count, tachycardia or low blood pressure, staff in the ED and ICU look at that evidence and think sepsis.

“You don’t ever want to create something that removes critical thinking,” says Marinelli of the protocol. “But it does let you know where you are in the process and presents best practice advisories to ensure outcomes are better.” Now, the goal is to spread the word throughout BWFH and the rest of Brigham Health.

To accomplish the goal, Brigham Health’s Sepsis Task Force is rolling out measures to educate all staff. They began by reviewing current sepsis management and reaching out to staff with a survey to identify areas for improvement. In the near future, they will provide updates with details of the sepsis care redesign efforts. “By identifying septic patients early, hopefully we can provide proper treatment quickly,” says Koffman.