Hello, Our hospital has found that using SIRS triggers alone leads to so many alerts with such low sensitivity that it was felt the alert wouldn't be meaningful to nurses. Instead, they created a formula based on actual data from coded septic patients. The formula takes into account some of the shared traits that the coded patients had in common. It weights components differently and then comes up with a score. When the score is high enough, and the patient has at least 2 SIRS criteria than an alert will trigger to the nurse who then has to decide if he/she is concerned about sepsis. If the nurse is concerned and answers "Yes" a page is automatically sent to the provider assigned to the patient and the hope is that the provider, pt nurse, and charge nurse huddle at the bedside to determine if sepsis care is warranted. Currently, we are in version one of the alerts, and the false alarms greatly outnumber the times where there is a real concern. However, by looking at data and making adjustments to the formula, we hope that we can improve the alert performance and help decrease alarm fatigue. It is a large IT burden.
More facts: I do not know what the formula is; it is extremely technical. I do know that things like the presence of a CVAD, positive respiratory cultures or bone marrow recipients are included in the formula and carry different scores according to their risks. We only use these on acute care units at this point. The alerts will only fire as frequently as every 12hrs, so even if the vitals or SIRS change 6 hrs after the nurse said "no" no alert will fire until a total of 12hrs has gone by and the alert components are still present. We do not have outcomes yet. As for your ideas here is my advice: Have some sort of way to see if the providers have already been paged about the same symptoms and teach nurses to evaluate if treatment has already been started. Both of those will help to decrease the number of provider pages. Good luck! Carrie Hayes MHA RN| Sepsis Coordinator Center for Clinical Excellence University of Washington Medical Center Mailbox 356033 Voice:206.598.3818 CONFIDENTIAL! The above email may contain patient identifiable or confidential information protected under Washington State RCW 4.24.250 and 70.41.200(3). Because email is not secure, please be aware of associated risks of email transmission. If you are a patient, communicating to a UW Medicine Provider via email implies your agreement to email communication; see http://www.uwmedicine.org/Global/Compliance/EmailRisk.htm The information is intended for the individual named above. If you are not the intended recipient, any disclosure, copying, distribution or use of the contents of this information is prohibited. Please notify the sender by reply email, and then destroy all copies of the message and any attachments. See our Notice of Privacy Practices at www.uwmedicine.org -----Original Message----- From: Sepsis group [mailto:[email protected]] On Behalf Of [email protected] Sent: Friday, November 17, 2017, 6:32 AM To: [email protected] Subject: Sepsisgroups Digest, Vol 269, Issue 2 Send Sepsis group mailing list submissions to [email protected] To subscribe or unsubscribe via the World Wide Web, visit http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org or, via email, send a message with subject or body 'help' to [email protected] You can reach the person managing the list at [email protected] When replying, please edit your Subject line so it is more specific than "Re: Contents of Sepsisgroups digest..." Today's Topics: 1. Re: Sepsis Best Practice Alerts (Orth, Claudia) ---------------------------------------------------------------------- Message: 1 Date: Wed, 15 Nov 2017 20:50:22 +0000 From: "Orth, Claudia" <[email protected]> To: jenny clarke <[email protected]>, Tara Miller <[email protected]> Cc: "[email protected]" <[email protected]> Subject: Re: [Sepsis Groups] Sepsis Best Practice Alerts Message-ID: <b482f481b7b4d745be676ceff55ec9406f67e...@mmc-exchmbs03.ad.mhc.net> Content-Type: text/plain; charset="utf-8" Would you be able to share what criteria is used to fire the Best Practice Alert (BPA). We currently have 2 alerts that fire: 1 for SIRS and 1 for SIRS PLUS organ dysfunction. We are thinking of blending the 2 together to perhaps give them a bit more sensitivity and specificity thereby decreasing some of the confusion and ?alert fatigue? we are experiencing. I am desperately seeking input and feedback on how other institutions have addressed this?i.e. what criteria triggers and alert, what is the response, is the alert sent out as a page or an open chart alert, etc. There is still reluctance to have ?alerts? go to providers so nursing currently carries the full burden of these. Our thought is to have an alert fire to nursing that would require a call to the provider if the following is present. Please feel free to critique and advise: 3/6 of the below criteria is present = EARLY WARNING ALERT FIRES 1. HR > 90 2. RR>20 3. Temp >38.5 or <36.0 4. WBC >12,000 or <4,000 or Bands >10% 5. Altered Level of Consciousness 6. SBP <90 ?Nurses order STAT Lactate level & the notify the Provider who needs to assess the patient and document why sepsis is being r/o or begin sepsis orders ? 3 hour bundle. This will also offload the current burden of nursing needing to decipher whether or not infection is present or should be suspected. *? Blends Sepsis 2 and Sepsis 3 definitions and streamlines/simplifies expected standard of care/roles & responsibilities. Similar to a Modified Early Warning Score? Thank you in advance for your much valued time, expertise, and anything you may be willing and able to share! Sincerely, Claudia Claudia Orth BSN, RN , CCRN-K Regional Sepsis Coordinator Clinical Quality Munson Medical Center Traverse City, Michigan 231-935-5692 [email protected]<mailto:[email protected]> From: Sepsisgroups [mailto:[email protected]] On Behalf Of jenny clarke Sent: Monday, November 06, 2017 3:25 PM To: Tara Miller <[email protected]> Cc: [email protected] Subject: Re: [Sepsis Groups] Sepsis Best Practice Alerts We set it up to not fire again once cleared by the nurse. But it will still fire for Dr and residents. Then ever 8 hours it reset. But I will say I am not sure it is helping. We did add GCS score to take into account neuro status. But it is still very hard to get nurses on floor to enter that with all vital signs. Still a struggle!! Sent from my iPhone On Nov 6, 2017, at 1:42 PM, Tara Miller <[email protected]<mailto:[email protected]>> wrote: We use EPIC as our EMR. We currently are using best practice alerts to fire off to the nursing staff when a patient meets SIRS criteria and then we have the nurse assess the patient and review the record for possible source of infection prior to initiating the sepsis code/ alert. Does anyone else use best practice alerts and use something other than SIRS criteria? We would like to make the alert more specific and cut down on all the firings throughout the day. Thanks. Tara R Miller, RN Team Leader, Quality Management Mobile Infirmary Medical Center Office: 435-5109 Cell: 605-8270 <image001.jpg> Confidentiality Notice: This electronic message, including any attachments, is for the sole use of the intended recipient(s) and may contain confidential and privileged information. Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the intended recipient, you are hereby notified that any disclosure, copying, distribution, or action taken in reliance on the contents of this electronic message and/or any attachments is strictly prohibited. This quality assurance document is for the use of Infirmary Health and is prepared and maintained pursuant to Section 22-21-8 of the 1975 Code of Alabama. 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