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Early Detection And Treatment of Severe Sepsis and Septic Shock PowerPoint Presentation

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This medical PowerPoint presentation talks about Sepsis, a potentially life-threatening condition that occurs when the bodys immune system overreacts to an infection, leading to widespread inflammation and organ dysfunction. Severe sepsis and septic shock are the most severe forms of sepsis, and require prompt and aggressive treatment in order to improve outcomes.

Early detection of severe sepsis and septic shock is crucial for initiating treatment as soon as possible.

Tags : Sepsis, critical care medicine, critical care medicine PowerPoint presentation

Published on : Mar 28, 2023 | Views : 1565 | Downloads : 2

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Slide 1-

Our Mission: improve the lives of our patients, families, and communities, educate skilled healthcare professionals, and conduct research that expands clinical knowledge. Physician Engagement Foundational Enablers Strategic Vectors Clinical Outcomes Patient Safety Technology Culture Organization & Staffing Our Vision for Quality & Safety of Care: We will be a Top Decile performer within 3 Years Our Vision: Stony Brook University Hospital will be: A world-class healthcare institution, recognized for excellence in patient care, research and health care education The first choice of patients for their care and the care of their families An academic medical center that attracts educators and students with the desire and ability to provide and receive the highest quality, innovative education One of the top ranked institutions for scientific research and training. Overview of Strategy for Quality Management Patient Experience Throughput Optimization Top Decile Outcomes Zero Preventable Harm Best Place to Receive Care Physician Driven Quality Program Technology Accelerated Care No Wasted Time or Resources Quality Management At Your Service Culture of Excellence & Accountability 1
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Early Detection and Treatment of Severe Sepsis and Septic Shock Stony Brook University Medical Center January 2019
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Surviving Severe Sepsis and Septic Shock More than 1.5 million people get sepsis each year One in three patients who die in a hospital have sepsis Severe sepsis is the leading cause of death in the non-coronary ICU The New York State 2016 Sepsis Care Improvement Initiative reported an overall severe sepsis and septic shock mortality rate of 25%-32%
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Effective May 1, 2013 NYSDOH Title 10 New York Codes Rules and Regulations (NYCRR) Sections 405.2 and 405.4 were amended to require that hospitals have in place evidence-based protocols for the early recognition and treatment of patients with severe sepsis and septic shock that are based on generally accepted standards of care. Population Inpatient adults (≥18 y/o) and children (<18 y/o). Diagnoses of Severe Sepsis or Septic Shock New York State Department of Health (NYSDOH) Reporting
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CMS Core Measure (SEP-1) Population Inpatients age 18 and over Diagnosis of Sepsis, Severe Sepsis, or Septic Shock Center for Medicare and Medicaid Services (CMS) Reporting
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Adherence to protocol guidelines will improve patient mortality outcomes! Hospital Inpatient Quality Reporting is ‘Pay for Performance’ Stony Brook must participate in all mandatory Inpatient Quality Reporting Measures Public Reporting of CMS and NYSDOH data Why This Is Important
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Defining The Septic Picture SIRS (Systemic inflammatory response syndrome): The clinical syndrome that results from a deregulated inflammatory response or to a noninfectious insult. Sepsis: SIRS that is secondary to infection that has been diagnosed clinically. Positive cultures add to the validity but are not required for the diagnosis. Severe Sepsis: Sepsis plus at least one of the signs of hypoperfusion or organ dysfunction that is new, and not explained by other known etiology of organ dysfunction. Septic Shock: Severe sepsis associated with persistent hypotension (BP<90/60) despite adequate fluid resuscitation and/or a serum lactate level >=4.0 mmol/L.
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Documentation of a suspected source of clinical infection B. Two or more manifestations of systemic infection according to the SIRS criteria, which are: Temperature > 38.3 C/101 F or < 36.0 C/96.8 F Heart rate > 90 bpm Respiration > 20 per min WBC > 12,000 or < 4,000 (k/uL) or > 10% bands C. Organ dysfunction, evidenced by any one of the following: SBP < 90 (mmHg), or MAP < 65 (mmHg), or a SBP decrease of more than 40 pts (if documented by LIP as due to infection) Cr > 2.0 (mg/dL), or urine output < 0.5 mL/kg/hour for 2 hours Bilirubin > 2 mg/dL (34.2 mmol/L) Platelet count < 100,000 (k/uL) INR > 1.5 or a PTT > 60 sec Lactate > 2 mmol/L (18.0 mg/dL) Acute respiratory failure requiring a new need for invasive or non-invasive mechanical ventilation OR Physician/NP/PA documentation of severe sepsis Adult Severe Sepsis CriteriaAll three of the following must be met within 6 hours of each other.
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• Patient meets Severe Sepsis criteria AND either: • Lactic acid ≥4 mmol/L OR • Persistent Hypotension in the hour following crystalloid fluid bolus OR • Physician/Advanced Practitioner diagnosis Septic Shock Criteria
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Lactate Collection Blood culture collection prior to broad spectrum antibiotics Early and appropriate broad-spectrum antibiotic administration Interventions within 3 Hours of Recognition
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Reminder! Blood cultures must be collected prior to antibiotic administration time. Check that the collection time is correct on all blood culture orders before sending to the lab Nurses may override the Pyxis for the first dose of certain broad spectrum antibiotics in the treatment of severe sepsis/septic shock, become familiar with those available in your area! Timely antibiotic administration is a priority in the treatment of sepsis!!
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Crystalloid fluid resuscitation (30 ml/kg) must be initiated within 3 hours of: Septic shock presentation Crystalloid fluid resuscitation (30 ml/kg) must be completed within 6 hours of: Septic shock, by diagnosis or clinical criteria OR Lactic Acid ≥4 mmol OR Any episode of hypotension (SBP <90 or MAP<65 mmHg) within 6 hours following severe sepsis presentation time. Fluid Resuscitation
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Re-measure lactate if the initial value was elevated (>2.0 mmol/L) Interventions within 6 Hours of Recognition Cerner Lactate Re-Order Rule Screens lactate results ≥ 2.1 for Inpatient, Emergency and Observation patients The system generates another Lactic Acid with the start of current time + 4 hours, with a frequency of 2 times If the first result of the first system generated order comes back <2.1 the second system order is discontinued
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Vasopressor therapy for persistent hypotension (MAP <65 mmHg in adults) IF hypotension persists after fluid administration Includes a repeat volume status and tissue perfusion assessment within 6 hours of presentation of Septic Shock Interventions within 6 Hours of Recognition contd.
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A focused exam performed/reviewed by physician/advanced practitioner must be documented, including: Vital Signs Cardiopulmonary Capillary refill Peripheral pulses Skin Volume Status and Tissue Perfusion Assessment
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Bundle Variance Documentation Refusal of care must be specifically documented within 6 hours of the presentation of severe sepsis or septic shock for: Antibiotics Blood Draws IV Fluids Vasopressors Comfort Measures or Palliative Care Within 3 hours of the presentation of severe sepsis Within 6 hours of the presentation of septic shock
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Pediatric Sepsis
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Pediatric age-specific SIRS criteria
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Pediatric Septic Shock Criteria Sepsis plus one of the following: Respiratory Dysfunction OR Two or more other organ dysfunctions Pediatric Severe Sepsis Criteria Sepsis and cardiovascular organ dysfunction Pediatric Organ Dysfunction Criteria Cardiovascular Respiratory Neurologic Renal Hepatic
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Early Detection and Treatment of Severe Sepsis Recognition to Immediate Treatment The Pediatric Acute Sepsis Multiphase Power plan
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Electronic Sepsis Screening Alerts
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2 SIRS criteria within a 5hr period will trigger a task to fire in Cerner for the bedside nurse to evaluate their patient for suspicion of infection. If an infection is suspected, the RN contacts the physician for a sepsis workup. The RN documents name of physician and date/time notified. If the nurse answers “yes” to a suspicion of infection, a lactate is ordered via option on the admission power plan. The Adult and Pediatric Sepsis Power plans are offered under suggested power plans. If the screen is found to be negative, complete the task as “No.” Comments should be entered, the section should not be left incomplete Once addressed, the alert will not fire again for an 8 hour period. Cerner Sepsis Screening Alert
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The Pediatric Amendment Applying the alert to our pediatric population required creation of seven additional “rules” for age specific criteria. Power plan prompts Duration adjustments in the ED
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Sepsis Alert Recognition-Nursing Mandatory fields answered by the RN, including notification and comments regarding their decision. Physician notification Generates serum lactate draws based on Admission Power Plan orders. Includes suggestions of Sepsis Power plan use for treatment.
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This alert will appear whenever a physician opens the patient’s chart and the following criteria have been met: 2 SIRS criteria + 1 Organ Dysfunction (within 6 hours of each other) The alert will ask the provider to agree or disagree with severe sepsis or allow documentation of comfort measure initiation or refusal of treatment. Cerner Severe Sepsis Screening Alert
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Severe Sepsis Recognition Provider If the provider agrees, , the alert generates an order stating severe sepsis is present. If criteria are not already met, this would be the Protocol Initiation Time and all elements of the bundles must be completed within 3 and 6 hours respectively. If the provider disagrees, the alert will desist for 12 hours and an order will be generated documenting the patient does not have severe sepsis. If the patient or family has refused treatment or comfort measures are initiated, a form will open to document and a clinical note will be generated.
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Severe Sepsis Recognition Pager Workflow Patient meets severe sepsis criteria Pager fires to location Clinical Nurse Specialist (CNS) or designee Page identifies the patient and location of the sepsis alert CNS or designee reviews the sepsis dashboard CNS or designee speaks to the provider responsible for the patient and asks them to assess the patient and respond to the severe sepsis alert. The sepsis dashboard is reviewed by the provider and CNS or designee and outstanding bundle elements implemented if appropriate.
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Identifies patients who meet clinical criteria for severe sepsis Provides visual indicator of when criteria was met or potential time zero Hovering over lines identifies criteria used to determine severe sepsis presence or intervention details. Provides timeline for interventions required and visual cues for which interventions are still outstanding Auto refreshes every 10 minutes Sepsis Dashboard
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Severe Sepsis Documentation Clinical Notes – Comfort Measures/Refusal of Treatment Note Generated Orders- Severe Sepsis Present Order is generated with Physician Name, Date, and Time
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Cerner Septic Shock Screening Alert If the provider has “agreed” to the severe sepsis alert, the Septic Shock Alert will look for: Lactic acid >4 mmol/L with 6 hours If criteria is found the alert will fire, notifying the provider of potential septic shock.
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Septic Shock Alert Documentation If the provider agrees with the alert, he/she will be prompted to complete a focused exam. An order is generated stating Septic Shock is Present. If the provider disagrees, an order will be generated stating septic shock is not present.
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Boxes Septic Shock Alert Form The boxes auto fill with data last charted, i.e. vital signs and elements for review, which will include documentation from Iview. The provider will click on the green check mark to complete the form.
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Septic Shock- Chart Documentation Clinical Notes Orders- this order will appear when the provider has clicked “disagree with septic shock”
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In Summary… Early recognition is essential Lactate is an early predictor of organ dysfunction Early fluid resuscitation and administration of antibiotics is critical Sepsis Powerplans and Caresets are available and up-to-date
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LMS Questions If not already initiated, which bundle elements must be initiated within 3 hours of severe sepsis presentation? Lactate Level Blood culture and broad spectrum antibiotic Initiation of fluid resuscitation with any instance of hypotension All of the above A patient is considered to have septic shock if they have a lactic acid result ≥4 mmol/L within 6 hours of severe sepsis presentation. T/F? What is the initial fluid requirement for an adult with severe sepsis and initial hypotension or septic shock? 20 mL/kg/hr crystalloid fluids 30 mL/kg/hr crystalloid fluids 20 mL/kg/hr crystalloid fluids or colloid fluids 30 mL/kg/hr crystalloid fluids or colloid fluids 4. When must a lactate level be redrawn if the initial result was >2 mmol/L? Within 2 hours of severe sepsis presentation Within 4 hours of severe sepsis presentation Within 6 hours of severe sepsis presentation Lactate level does not need to be repeated The physician/advanced practitioner must document that he/she has reviewed, performed or attested to reviewing or performing a cardiopulmonary reassessment after the initiation of crystalloid fluids but no later than 6 hours after the presentation of septic shock. T/F? The first dose of a broad spectrum antibiotic for the treatment of severe sepsis/septic shock is available for override in the Pyxis on all nursing units. T/F?
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References Dellinger, R. Phillip et al, Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock: 2012. Critical Care Medicine, Feb. 2013. Vol. 41, No.2. Goldstein, Brahm, et al, International Pediatrics Sepsis Consensus Conference: Definitions for sepsis and organ dysfunction in Pediatrics. Pediatric Critical Care Medicine, 2005, Vol.6 No. 1. Surviving Sepsis Campaign: An international collaborative recommending resuscitation and management care bundles for the recognition and treatment of sepsis/septic shock. Recommendations were first published as in Critical Care Medicine, Mar 2004. Link to Policy