Re: [Sepsis Groups] Sepsis Best Practice Alerts

[Haines, David R]

Thank you

From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of Haines, David R
Sent: Monday, November 27, 2017 12:57 PM
To: Posani, Theresa; Orth, Claudia; jenny clarke; Tara Miller
Cc: sepsisgroups@lists.sepsisgroups.org
Subject: Re: [Sepsis Groups] Sepsis Best Practice Alerts

Hi can anyone provide me with any literature on the fact that approx. 8  hours 
prior to a patient arresting that there is a trend change in their vital signs?
Thank you
David

From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of Posani, Theresa
Sent: Friday, November 17, 2017 9:43 AM
To: Orth, Claudia; jenny clarke; Tara Miller
Cc: 
sepsisgroups@lists.sepsisgroups.org<mailto:sepsisgroups@lists.sepsisgroups.org>
Subject: Re: [Sepsis Groups] Sepsis Best Practice Alerts


WARNING: This email originated from outside of Beaumont Health.
Do not click on any links or open any attachments unless you recognize the 
sender and are expecting the message.
Claudia,
We use all of the following:
shock index (>0.70 (HR/SBP = SI)
plus SIRS + (2 or more)
plus MEWS (4 or more)
= firing of the sepsis BPA.
I have noticed more appropriate firing of our sepsis BPA.
It is not perfect; but, it is an improvement on the inpatient non-ICU areas 
than using either the SIRS or MEWS individually.
It does not fire in either the ICUs or the ED.
Thoughts?
Theresa

Theresa Posani, MS, RN, ACNS-BC | Med/Surg CNS/Sepsis Coordinator
T 817.250-3907 | M 972.838-7954
theresapos...@texashealth.org<mailto:theresapos...@texashealth.org>

[https://brandcenter.txhealth.org/logos-templates/Logos/Locations%20(Wholly-Owned)/Texas%20Health%20Fort%20Worth/No%20Tagline/RGB-Email%20Signature/THFortWorth-email.jpg]

From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of Orth, Claudia
Sent: Wednesday, November 15, 2017 2:50 PM
To: jenny clarke <j...@live.com<mailto:j...@live.com>>; Tara Miller 
<tara.mil...@infirmaryhealth.org<mailto:tara.mil...@infirmaryhealth.org>>
Cc: 
sepsisgroups@lists.sepsisgroups.org<mailto:sepsisgroups@lists.sepsisgroups.org>
Subject: Re: [Sepsis Groups] Sepsis Best Practice Alerts

[EXTERNAL]
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
cor...@mhc.net<mailto:cor...@mhc.net>




From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of jenny clarke
Sent: Monday, November 06, 2017 3:25 PM
To: Tara Miller 
<tara.mil...@infirmaryhealth.org<mailto:tara.mil...@infirmaryhealth.org>>
Cc: 
sepsisgroups@lists.sepsisgroups.org<mailto:sepsisgroups@lists.sepsisgroups.org>
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 
<tara.mil...@infirmaryhealth.org<mailto:tara.mil...@infirmaryhealth.o

Re: [Sepsis Groups] Sepsis Best Practice Alerts

[Taylor, Barbara A]

We utilize BPA’s for nursing in the ED and inpatient areas.


Barbara A. Taylor, MSN, BS, RN
Performance Improvement Coordinator
Lancaster General Hospital /Penn Medicine
555 N. Duke St.
P.O. Box 3555
Lancaster, Pa. 17602
717-544-5924



From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of Crabtree, Pam
Sent: Monday, November 27, 2017 2:14 PM
To: Posani, Theresa <theresapos...@texashealth.org>; Orth, Claudia 
<cor...@mhc.net>; jenny clarke <j...@live.com>; Tara Miller 
<tara.mil...@infirmaryhealth.org>
Cc: sepsisgroups@lists.sepsisgroups.org
Subject: Re: [Sepsis Groups] Sepsis Best Practice Alerts

Thanks Theresa,

Great information! I will be checking in with you after the 1st!! Happy Holiday 
to you as well!!


Pamela Crabtree RN CPHQ|Quality Improvement Manager
Cooper University Health Care
Cooper Camden Business Office/ Operational Excellence Dept.
1 Federal Street/ Suite SE2-217C.
Camden, NJ 08103-1162|(office) 856.382.6635
crabtree-...@cooperhealth.edu<mailto:crabtree-...@cooperhealth.edu>
KNOW Sepsis: Inside & Out
[cid:image001.png@01D28DC7.AFB18220]



From: Posani, Theresa [mailto:theresapos...@texashealth.org]
Sent: Monday, November 27, 2017 2:00 PM
To: Crabtree, Pam; Orth, Claudia; jenny clarke; Tara Miller
Cc: 
sepsisgroups@lists.sepsisgroups.org<mailto:sepsisgroups@lists.sepsisgroups.org>
Subject: RE: [Sepsis Groups] Sepsis Best Practice Alerts

Thank you Pam.
We have only been using this for about 2 months.  So it is still too early to 
give you the information you requested.
That being said I can say from a reviewer point of view I am identifying more 
accurately septic patients based on the scores.
Our previous sepsis screening started off with the ED nurse answering the 
question “does the patient have a potential infection?”.
You can guess the issues with that question – too busy and did not want to work 
patient up – was a common comment when I followed up with many of the ED nurses.
Tentatively, it looks to be about 95% sensitive.  Specificity about 93%.  I 
hope I am remembering the numbers discussed last week at our system wide sepsis 
meeting.
They (IT group) have been fine tubing it since it started.
The first week (9/20th) it was horrible in the ED with many false positives 
triggering our sepsis BPA (best practice alerts) to the MDs and RNs.  Many, 
many complaints.
Check with me after the first of the year and hopefully there will be more 
“official” numbers to report.
Happy Holidays!.
Theresa

Theresa Posani, MS, RN, ACNS-BC | Med/Surg CNS/Sepsis Coordinator
T 817.250-3907 | M 972.838-7954
theresapos...@texashealth.org<mailto:theresapos...@texashealth.org>

[https://brandcenter.txhealth.org/logos-templates/Logos/Locations%20(Wholly-Owned)/Texas%20Health%20Fort%20Worth/No%20Tagline/RGB-Email%20Signature/THFortWorth-email.jpg]

From: Crabtree, Pam [mailto:crabtree-...@cooperhealth.edu]
Sent: Monday, November 27, 2017 12:39 PM
To: Posani, Theresa 
<theresapos...@texashealth.org<mailto:theresapos...@texashealth.org>>; Orth, 
Claudia <cor...@mhc.net<mailto:cor...@mhc.net>>; jenny clarke 
<j...@live.com<mailto:j...@live.com>>; Tara Miller 
<tara.mil...@infirmaryhealth.org<mailto:tara.mil...@infirmaryhealth.org>>
Cc: 
sepsisgroups@lists.sepsisgroups.org<mailto:sepsisgroups@lists.sepsisgroups.org>
Subject: RE: [Sepsis Groups] Sepsis Best Practice Alerts

[EXTERNAL]
Hi Theresa Ponsani,

I like your criteria- I am curious- I would be interested in knowing how long 
they have been using this logic and what their false positive, true positive, 
false negative and true negative rates are.

Thanks,


Pamela Crabtree RN CPHQ|Quality Improvement Manager
Cooper University Health Care
Cooper Camden Business Office/ Operational Excellence Dept.
1 Federal Street/ Suite SE2-217C.
Camden, NJ 08103-1162|(office) 856.382.6635
crabtree-...@cooperhealth.edu<mailto:crabtree-...@cooperhealth.edu>
KNOW Sepsis: Inside & Out
[cid:image001.png@01D28DC7.AFB18220]





From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of Posani, Theresa
Sent: Friday, November 17, 2017 9:43 AM
To: Orth, Claudia; jenny clarke; Tara Miller
Cc: 
sepsisgroups@lists.sepsisgroups.org<mailto:sepsisgroups@lists.sepsisgroups.org>
Subject: Re: [Sepsis Groups] Sepsis Best Practice Alerts

Claudia,
We use all of the following:
shock index (>0.70 (HR/SBP = SI)
plus SIRS + (2 or more)
plus MEWS (4 or more)
= firing of the sepsis BPA.
I have noticed more appropriate firing of our sepsis BPA.
It is not perfect; but, it is an improvement on the inpatient non-ICU areas 
than using either the SIRS or MEWS individually.
It does not fire in either the ICUs or the ED.
Thoughts?
Theresa

Theresa Posani, MS, RN, ACNS-BC | Med/Surg CNS/Sepsis Coordinator
T 817.250-3907 | M 972.838-7954
theresapos...@texashealth.org<mailto:theresapos...@texashealth.org>

[https://b

Re: [Sepsis Groups] Sepsis Best Practice Alerts

[Posani, Theresa]

Thank you Pam.
We have only been using this for about 2 months.  So it is still too early to 
give you the information you requested.
That being said I can say from a reviewer point of view I am identifying more 
accurately septic patients based on the scores.
Our previous sepsis screening started off with the ED nurse answering the 
question “does the patient have a potential infection?”.
You can guess the issues with that question – too busy and did not want to work 
patient up – was a common comment when I followed up with many of the ED nurses.
Tentatively, it looks to be about 95% sensitive.  Specificity about 93%.  I 
hope I am remembering the numbers discussed last week at our system wide sepsis 
meeting.
They (IT group) have been fine tubing it since it started.
The first week (9/20th) it was horrible in the ED with many false positives 
triggering our sepsis BPA (best practice alerts) to the MDs and RNs.  Many, 
many complaints.
Check with me after the first of the year and hopefully there will be more 
“official” numbers to report.
Happy Holidays!.
Theresa

Theresa Posani, MS, RN, ACNS-BC | Med/Surg CNS/Sepsis Coordinator
T 817.250-3907 | M 972.838-7954
theresapos...@texashealth.org<mailto:theresapos...@texashealth.org>

[https://brandcenter.txhealth.org/logos-templates/Logos/Locations%20(Wholly-Owned)/Texas%20Health%20Fort%20Worth/No%20Tagline/RGB-Email%20Signature/THFortWorth-email.jpg]

From: Crabtree, Pam [mailto:crabtree-...@cooperhealth.edu]
Sent: Monday, November 27, 2017 12:39 PM
To: Posani, Theresa <theresapos...@texashealth.org>; Orth, Claudia 
<cor...@mhc.net>; jenny clarke <j...@live.com>; Tara Miller 
<tara.mil...@infirmaryhealth.org>
Cc: sepsisgroups@lists.sepsisgroups.org
Subject: RE: [Sepsis Groups] Sepsis Best Practice Alerts

[EXTERNAL]
Hi Theresa Ponsani,

I like your criteria- I am curious- I would be interested in knowing how long 
they have been using this logic and what their false positive, true positive, 
false negative and true negative rates are.

Thanks,


Pamela Crabtree RN CPHQ|Quality Improvement Manager
Cooper University Health Care
Cooper Camden Business Office/ Operational Excellence Dept.
1 Federal Street/ Suite SE2-217C.
Camden, NJ 08103-1162|(office) 856.382.6635
crabtree-...@cooperhealth.edu<mailto:crabtree-...@cooperhealth.edu>
KNOW Sepsis: Inside & Out
[cid:image001.png@01D28DC7.AFB18220]





From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of Posani, Theresa
Sent: Friday, November 17, 2017 9:43 AM
To: Orth, Claudia; jenny clarke; Tara Miller
Cc: 
sepsisgroups@lists.sepsisgroups.org<mailto:sepsisgroups@lists.sepsisgroups.org>
Subject: Re: [Sepsis Groups] Sepsis Best Practice Alerts

Claudia,
We use all of the following:
shock index (>0.70 (HR/SBP = SI)
plus SIRS + (2 or more)
plus MEWS (4 or more)
= firing of the sepsis BPA.
I have noticed more appropriate firing of our sepsis BPA.
It is not perfect; but, it is an improvement on the inpatient non-ICU areas 
than using either the SIRS or MEWS individually.
It does not fire in either the ICUs or the ED.
Thoughts?
Theresa

Theresa Posani, MS, RN, ACNS-BC | Med/Surg CNS/Sepsis Coordinator
T 817.250-3907 | M 972.838-7954
theresapos...@texashealth.org<mailto:theresapos...@texashealth.org>

[https://brandcenter.txhealth.org/logos-templates/Logos/Locations%20(Wholly-Owned)/Texas%20Health%20Fort%20Worth/No%20Tagline/RGB-Email%20Signature/THFortWorth-email.jpg]

From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of Orth, Claudia
Sent: Wednesday, November 15, 2017 2:50 PM
To: jenny clarke <j...@live.com<mailto:j...@live.com>>; Tara Miller 
<tara.mil...@infirmaryhealth.org<mailto:tara.mil...@infirmaryhealth.org>>
Cc: 
sepsisgroups@lists.sepsisgroups.org<mailto:sepsisgroups@lists.sepsisgroups.org>
Subject: Re: [Sepsis Groups] Sepsis Best Practice Alerts

[EXTERNAL]
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

Re: [Sepsis Groups] Sepsis Best Practice Alerts

[Haines, David R]

Hi can anyone provide me with any literature on the fact that approx. 8  hours 
prior to a patient arresting that there is a trend change in their vital signs?
Thank you
David

From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of Posani, Theresa
Sent: Friday, November 17, 2017 9:43 AM
To: Orth, Claudia; jenny clarke; Tara Miller
Cc: sepsisgroups@lists.sepsisgroups.org
Subject: Re: [Sepsis Groups] Sepsis Best Practice Alerts


WARNING: This email originated from outside of Beaumont Health.
Do not click on any links or open any attachments unless you recognize the 
sender and are expecting the message.
Claudia,
We use all of the following:
shock index (>0.70 (HR/SBP = SI)
plus SIRS + (2 or more)
plus MEWS (4 or more)
= firing of the sepsis BPA.
I have noticed more appropriate firing of our sepsis BPA.
It is not perfect; but, it is an improvement on the inpatient non-ICU areas 
than using either the SIRS or MEWS individually.
It does not fire in either the ICUs or the ED.
Thoughts?
Theresa

Theresa Posani, MS, RN, ACNS-BC | Med/Surg CNS/Sepsis Coordinator
T 817.250-3907 | M 972.838-7954
theresapos...@texashealth.org<mailto:theresapos...@texashealth.org>

[https://brandcenter.txhealth.org/logos-templates/Logos/Locations%20(Wholly-Owned)/Texas%20Health%20Fort%20Worth/No%20Tagline/RGB-Email%20Signature/THFortWorth-email.jpg]

From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of Orth, Claudia
Sent: Wednesday, November 15, 2017 2:50 PM
To: jenny clarke <j...@live.com<mailto:j...@live.com>>; Tara Miller 
<tara.mil...@infirmaryhealth.org<mailto:tara.mil...@infirmaryhealth.org>>
Cc: 
sepsisgroups@lists.sepsisgroups.org<mailto:sepsisgroups@lists.sepsisgroups.org>
Subject: Re: [Sepsis Groups] Sepsis Best Practice Alerts

[EXTERNAL]
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
cor...@mhc.net<mailto:cor...@mhc.net>




From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of jenny clarke
Sent: Monday, November 06, 2017 3:25 PM
To: Tara Miller 
<tara.mil...@infirmaryhealth.org<mailto:tara.mil...@infirmaryhealth.org>>
Cc: 
sepsisgroups@lists.sepsisgroups.org<mailto:sepsisgroups@lists.sepsisgroups.org>
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 
<tara.mil...@infirmaryhealth.org<mailto:tara.mil...@infirmaryhealth.org>> 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 somethin

Re: [Sepsis Groups] Sepsis Best Practice Alerts

[Crabtree, Pam]

Hi Theresa Ponsani,

I like your criteria- I am curious- I would be interested in knowing how long 
they have been using this logic and what their false positive, true positive, 
false negative and true negative rates are.

Thanks,


Pamela Crabtree RN CPHQ|Quality Improvement Manager
Cooper University Health Care
Cooper Camden Business Office/ Operational Excellence Dept.
1 Federal Street/ Suite SE2-217C.
Camden, NJ 08103-1162|(office) 856.382.6635
crabtree-...@cooperhealth.edu<mailto:crabtree-...@cooperhealth.edu>
KNOW Sepsis: Inside & Out
[cid:image001.png@01D28DC7.AFB18220]





From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of Posani, Theresa
Sent: Friday, November 17, 2017 9:43 AM
To: Orth, Claudia; jenny clarke; Tara Miller
Cc: sepsisgroups@lists.sepsisgroups.org
Subject: Re: [Sepsis Groups] Sepsis Best Practice Alerts

Claudia,
We use all of the following:
shock index (>0.70 (HR/SBP = SI)
plus SIRS + (2 or more)
plus MEWS (4 or more)
= firing of the sepsis BPA.
I have noticed more appropriate firing of our sepsis BPA.
It is not perfect; but, it is an improvement on the inpatient non-ICU areas 
than using either the SIRS or MEWS individually.
It does not fire in either the ICUs or the ED.
Thoughts?
Theresa

Theresa Posani, MS, RN, ACNS-BC | Med/Surg CNS/Sepsis Coordinator
T 817.250-3907 | M 972.838-7954
theresapos...@texashealth.org<mailto:theresapos...@texashealth.org>

[https://brandcenter.txhealth.org/logos-templates/Logos/Locations%20(Wholly-Owned)/Texas%20Health%20Fort%20Worth/No%20Tagline/RGB-Email%20Signature/THFortWorth-email.jpg]

From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of Orth, Claudia
Sent: Wednesday, November 15, 2017 2:50 PM
To: jenny clarke <j...@live.com<mailto:j...@live.com>>; Tara Miller 
<tara.mil...@infirmaryhealth.org<mailto:tara.mil...@infirmaryhealth.org>>
Cc: 
sepsisgroups@lists.sepsisgroups.org<mailto:sepsisgroups@lists.sepsisgroups.org>
Subject: Re: [Sepsis Groups] Sepsis Best Practice Alerts

[EXTERNAL]
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
cor...@mhc.net<mailto:cor...@mhc.net>




From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of jenny clarke
Sent: Monday, November 06, 2017 3:25 PM
To: Tara Miller 
<tara.mil...@infirmaryhealth.org<mailto:tara.mil...@infirmaryhealth.org>>
Cc: 
sepsisgroups@lists.sepsisgroups.org<mailto:sepsisgroups@lists.sepsisgroups.org>
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 
<tara.mil...@infirmaryhealth.org<mailto:tara.mil...@infirmaryhealth.org>> wrote:
We use EPIC as our EMR. We currently are using best practice alerts to fire off 
to the nursing staff

Re: [Sepsis Groups] Sepsis Best Practice Alerts

[Posani, Theresa]

Claudia,
We use all of the following:
shock index (>0.70 (HR/SBP = SI)
plus SIRS + (2 or more)
plus MEWS (4 or more)
= firing of the sepsis BPA.
I have noticed more appropriate firing of our sepsis BPA.
It is not perfect; but, it is an improvement on the inpatient non-ICU areas 
than using either the SIRS or MEWS individually.
It does not fire in either the ICUs or the ED.
Thoughts?
Theresa

Theresa Posani, MS, RN, ACNS-BC | Med/Surg CNS/Sepsis Coordinator
T 817.250-3907 | M 972.838-7954
theresapos...@texashealth.org<mailto:theresapos...@texashealth.org>

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From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of Orth, Claudia
Sent: Wednesday, November 15, 2017 2:50 PM
To: jenny clarke <j...@live.com>; Tara Miller <tara.mil...@infirmaryhealth.org>
Cc: sepsisgroups@lists.sepsisgroups.org
Subject: Re: [Sepsis Groups] Sepsis Best Practice Alerts

[EXTERNAL]
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
cor...@mhc.net<mailto:cor...@mhc.net>




From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of jenny clarke
Sent: Monday, November 06, 2017 3:25 PM
To: Tara Miller 
<tara.mil...@infirmaryhealth.org<mailto:tara.mil...@infirmaryhealth.org>>
Cc: 
sepsisgroups@lists.sepsisgroups.org<mailto:sepsisgroups@lists.sepsisgroups.org>
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 
<tara.mil...@infirmaryhealth.org<mailto:tara.mil...@infirmaryhealth.org>> 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



Confidentiality Notice:  This electronic message, including any attachments, is 
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strictly prohibited.  This quality assur

Re: [Sepsis Groups] Sepsis Best Practice Alerts

[Orth, Claudia]

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
cor...@mhc.net<mailto:cor...@mhc.net>




From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of jenny clarke
Sent: Monday, November 06, 2017 3:25 PM
To: Tara Miller <tara.mil...@infirmaryhealth.org>
Cc: sepsisgroups@lists.sepsisgroups.org
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 
<tara.mil...@infirmaryhealth.org<mailto:tara.mil...@infirmaryhealth.org>> 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



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Re: [Sepsis Groups] Sepsis Best Practice Alerts

[jenny clarke]

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 
> 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



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. Prepared in an anticipation of litigation.

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Re: [Sepsis Groups] Sepsis Best Practice Alerts

[Merwin, Courtney C.]

We use Cerner as our EMR and our alert fires based on SIRS and Organ 
dysfunction criteria.   If the RN verifies that the SIRS and Organ dysfunction 
criteria are correct and there is a suspected source of infection, the System 
will automatically place orders for Lactic acid and Blood cultures and the RN 
gets a task to "Notify Physician" and ask about orders for antibiotics/fluids.

It's not perfect and there are still plenty of false positive alerts.

Courtney Merwin BS, RRT
Quality Management
East Jefferson General Hospital
4200 Houma Blvd.
Metairie, LA  70006
504-503-5968
ccmer...@ejgh.org<mailto:ccmer...@ejgh.org>


From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of Tara Miller
Sent: Wednesday, November 01, 2017 4:02 PM
To: 'sepsisgroups@lists.sepsisgroups.org'
Subject: [Sepsis Groups] Sepsis Best Practice Alerts

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

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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. Prepared in an anticipation of litigation.

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[Sepsis Groups] Sepsis Best Practice Alerts

[Tara Miller]

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

[IH_Logo_20170609]

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. Prepared in an anticipation of litigation.

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