Suspect sepsis

September 21st, 2017

Sept. 20, 2017 — “Welcome to the sepsis team,” Lori Muhr tells nurses as she distributes new sepsis-specific badge backers at Nursing Grand Rounds, driving home her message that sepsis is everybody’s business.

Sepsis Badge

JPS sees an average of 206 sepsis patients every month, said Muhr, director of Clinical Performance Improvement and project manager for the JPS Sepsis Task Force.

Sepsis patients may arrive through any door at any clinic with seemingly unrelated complaints. “Trauma sees patients who come in because they fell down. Why did they fall down?” Could be because sepsis caused their blood pressure to drop, making them dizzy when they stood up out of bed, Muhr explains.

In fact, the first case recorded on the JPS Sepsis Registry was an outpatient in the Podiatry clinic. The 70-year-old man came in for a scheduled follow-up appointment. Fortunately, the resident who saw him recognized signs of sepsis and sent him to the E.R., where he got IV fluids and antibiotics before being transferred to the ICU.

“Who at JPS has nothing to do with sepsis patients?” Muhr asked. “Nobody!”

Sepsis, the ninth leading cause of death in the United States, occurs secondary to infection as the immune system triggers release of chemicals that cause bloodstream inflammation. About one third of people who get sepsis will die. Early diagnosis is key, as the mortality rate rises eight percent every hour that a sepsis patient goes undiagnosed.

Signs include a fever higher than 101 degrees (or lower than 97), elevated heart rate above 90, rapid breathing (respiratory rate higher than 20), and an abnormal white blood cell count (too high or too low). Sepsis should be suspected, Muhr said, in a patient who has two of those signs plus a possible source of infection, which could be anything from a wound, pneumonia, urinary tract infection or recent dental work or medical procedure.

Sepsis Badge

Nurses at JPS can order a sepsis consult for any hospitalized patient with possible sepsis — a protocol designed to further lower the mortality rate, which at JPS has fallen to 13.8 from from 19.1 percent in 2013. Sepsis consults are provided at no extra charge for hospitalized patients.

JPS was certified in sepsis care by The Joint Commission in September, becoming the only public hospital in the country with disease-specific certification in sepsis.

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