Knowledge and Teamwork in Fighting Sepsis
Sepsis strikes more than one million people each year, and in 15 to 30 percent of cases, it’s deadly. It’s a complex condition that isn’t easy to immediately recognize, but is treatable when identified in a timely fashion.
Sepsis is a complication that rises from an infection. Without proper treatment, sepsis can lead your body’s own defense systems to interrupt blood flow to vital organs.
It can also lead to extremely low blood pressure, which can be a fatal condition called septic shock.
"Avera has been working on improvements in recognizing and treating sepsis in a timely fashion for several years, and we’re implementing the lessons learned for training and awareness across our entire health system," said Jawad Nazir, MD, Avera Medical Group infectious disease specialist. "We can treat this condition successfully when we recognize it in a timely fashion, administer appropriate antibiotics and optimize the patient’s fluid levels."
"We can test for lactic acid, because when those levels are spiking, it’s a likely indicator of sepsis severity. Then, in a timely manner, we can use treatment protocols we have in place."
Comprehensive Toolkit for Fighting Back
Avera has integrated a sepsis-specific toolkit within its electronic health record. Avera also employs a widely accepted “best practice” in the form of what’s known as the "Three Hour Bundle" for initial management of these patients.
"The bundle allows us to keep simple a complicated process that goes with severe sepsis treatment," Nazir said. "In this case, it includes testing for lactic acid as well as blood culture collection. It also includes optimizing the patient’s fluids and the timely administration of appropriate antibiotics."
Avera has seen a decrease in sepsis-related deaths, but the overall effort presses forward, Nazir said, in part because the health system’s goal is to be among the top 1 percent of hospitals nationally in terms of prevention and treatment of this condition.
In 2017, the Centers for Medicare and Medicaid Services (CMS) began to review sepsis care as part of its paradigm for adjusted hospital payments, thus showing an increase in awareness and prevalence in health care as a whole.
"There’s been progress over the last five years," said Nazir. "We have the teams in place to discern trends and to look at the macro level across our system."
Complicated Symptoms Can Mask Sepsis
Ongoing awareness among care teams also includes information for patients. Sepsis is unlike many other conditions, in that its symptoms may overlap with common maladies such as the flu or a bad cold. People suffering from sepsis need immediate attention; the symptoms such as fever or cough, or a change in mental state for older adults, could be indicators.
"Most commonly, sepsis symptoms center around an unexpected cough, fever or change in mental state. They seem to come out of the blue," Nazir said. "When people just generally go from feeling OK to feeling terrible, it’s important for them to come in and be seen by a provider."
Since many conditions "act like" sepsis, a team effort where clinical suspicions can lead to direct action – delivered in a timely fashion – can save lives.
"When every member of a care team is doing the right thing, we have opportunities to reduce sepsis occurrence as well as sepsis-related mortality," he said. "We’re committed, across the board, to quality improvement, monitoring and process development."
If you or your family is a hospital patient, here are some key tips that can help you protect yourself or your loved ones from sepsis:
- What it is: Your body will respond in extreme when facing infection. In a nutshell, that’s sepsis, a life-threatening condition that can be fatal without timely treatment. It starts with an infection somewhere in your body and leads to a chain reaction. It’s a medical emergency.
- Symptoms: Confusion or disorientation, shortness of breath, high heart rate, fever, shivering or very cold feelings, extreme pain or discomfort and clammy, sweaty skin all are signs of sepsis, and may occur alone or in combination.
- Who’s at risk: Anyone can get an infection, and almost any infection can lead to sepsis. People with chronic conditions like cancer and diabetes are at higher risk, and sepsis is most common in people who are 65 and older. It also happens more in children 1 or younger as well as people who have weakened immune systems.
- What causes it: Staph and E. coli infections are the most common starting point for sepsis, but some types of streptococcus also can be the root of it.
- How to stop it: Ask your doctor about methods to avoid infection, and always practice good hygiene to include hand washing and keeping healing wounds clean and covered. Know the symptoms and act fast if you suspect sepsis or if you have an infection that isn’t improving.