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 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 <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. 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