Project Timeframe: December 2011 – ongoing
Problem: Severe sepsis is a seriously life threatening disorder, with identified national mortality rates of approximately 29%. Severe sepsis can occur in patients with an infectious source or in those experiencing a systemic inflammatory response (SIRS), a system-wide inflammation from a non-infectious source such as pancreatitis. Sepsis leads to decreased blood pressure, reduced blood supply to the patient’s internal organs, and ultimately organ failure and death. Timely assessment, diagnosis and treatment is critical to the patient’s well being. Dr. David Albright, Chief Medical Officer at BMH, recognized that while the hospital has established treatment protocols for many life threatening disorders, such as AMI, Stroke or Trauma, we did not have a clearly defined protocol for Severe Sepsis. To increase response time for appropriate diagnosis and treatment, and to increase safety and improved outcomes for our patients, a multi-disciplinary protocol was needed.
Goal: To develop a standard treatment protocol for the evaluation and treatment of patients at risk for developing Severe Sepsis, based on standardized, evidence based assessment tools.
Interventions: In December, 2011 we established a multidisciplinary team consisting of our Chief Medical Officer, Emergency Department Medical Director and Nurse Manager, Special Care Unit Nurse Manager, Lab Director and Pathologist. Based on the recommendations of the Institute for Healthcare Improvement, this committee developed a clearly defined protocol to screen all ED patients meeting two or more of the clinical indications for Sepsis, with specific indications for timely testing, evaluation and appropriate treatment. This protocol includes vey strict time frames to initiate assessment and treatment. Our IT staff collaborated with the Committee in the development of an on-line “order set” for Sepsis treatment — a multiple choice listing of interventions and follow-up testing options for use by physicians and nursing staff to support their clinical decision making and provide for increased patient safety.
Measures: 100% of all instances of use of this protocol are being audited for appropriate use, documentation and outcomes.
Results: We will continue to monitor utilization of this protocol and instances of severe sepsis over the coming months to provide data for analysis. Based on that analysis we will plan either continuation or modification of this protocol for increased patient safety.
Michele Rowland, RN, LICSW
Executive Director, Quality, Utilization and Care Management
Brattleboro Memorial Hospital
17 Belmont Avenue, Brattleboro, VT 05301