I find it interesting (and somewhat misguided) that people are trying to reduce
the frequency of "false alarm" alerts... (acknowledging that alarm fatigue is a
real entity!!!)
The whole point of a sepsis (or any) screening tool is to have a HIGH
sensitivity (ie NOT miss true cases) at the expense of firing off false alarms
(ie low specificity)
You dont want to reduce alerts.. you dont want to use "predictive analytics" to
hone down who is affected vs who is false alarm... that is NOT the goal of the
initial screening tool
You want the screening tool to be highly sensitive (ie "never" miss a true
sepsis case); a positive screen will then aim the focus of the clinical
team/physicians etc to more carefully evaluate the pt for progressive sepsis.
So its the subsequent evaluation AFTER a positive screen that hones down who is
true positive vs who is false positive
You can easily make the screening tool more specific (ie fewer false alarms) by
creating a screening tool that will only pick up pts that are about to die from
sepsis (altered mental status, grossly abnl vitals, severe shock, etc) but then
the screening tool is ineffective at its intended goal; which is to alert the
clinical team that the pt is starting to deteriorate NOT that the pt is about
to arrest
the surviving sepsis campaign has struggled with these concepts for years
(trying to balance sensitivity vs specificity); It's not their fault, its the
nature of the beast of screening tools
Respectfully
Thomas Westover MD, FACOGAsst Professor MFM and ObgynCooper Medical School,
Rowan University Vice Chair, NJ ACOGCo-Chair, NJ Hospital Association Statewide
Perinatal Safety CollaborativeCamden NJ
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Subject: Sepsisgroups Digest, Vol 270, Issue 1
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Today's Topics:
1. Re: [**External**] Re: Sepsis Best Practice Alerts
(Barnes-Daly, Mary Ann, MS, RN, CCRN, DC)
----------------------------------------------------------------------
Message: 1
Date: Fri, 17 Nov 2017 16:10:42 +0000
From: "Barnes-Daly, Mary Ann, MS, RN, CCRN, DC"
<[email protected]>
To: "Orth, Claudia" <[email protected]>, jenny clarke <[email protected]>,
"Tara Miller" <[email protected]>
Cc: "[email protected]"
<[email protected]>
Subject: Re: [Sepsis Groups] [**External**] Re: Sepsis Best Practice
Alerts
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At Sutter Health we have several:
First is ?possible sepsis? for Infection (active culture, problem list) plus
available SIRS
Second is ?possible severe sepsis? ? same as above plus available organ
dysfunction (excludes BUN/Cr for example for ESRD)
Third is ?possible septic shock? - above with Lactate > 4
1 and 2 fire only for RNs 3 fires for RN, and providers
We are moving toward predictive analytics(PA) ? and may or may not continue
with BPAs ? or just go to PA alerts where the recipient doesn?t need to be in
the chart to be notified, as with a BPA
Thanks,
MARY ANN BARNES-DALY MS RN CCRN DC | Clinical Performance Improvement
Consultant
Quality & Clinical Effectiveness Team | Office of Patient Experience
Sutter Health -2200 River Plaza Drive, Sacramento, CA 95833
Mobile 916.200.5604| [email protected]<mailto:[email protected]>
?Do the best you can until you know better. Then when you know better, do
better? Maya Angelou
[https://newsplus.sutterhealth.org/peninsula-coastal/files/2017/04/SH_Pride_Plus400-002-177x177.gif]
From: Sepsisgroups [mailto:[email protected]] On
Behalf Of Orth, Claudia
Sent: Wednesday, November 15, 2017 12:50 PM
To: jenny clarke <[email protected]>; Tara Miller <[email protected]>
Cc: [email protected]
Subject: [**External**] Re: [Sepsis Groups] Sepsis Best Practice Alerts
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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
[email protected]<mailto:[email protected]>
From: Sepsisgroups [mailto:[email protected]] On
Behalf Of jenny clarke
Sent: Monday, November 06, 2017 3:25 PM
To: Tara Miller
<[email protected]<mailto:[email protected]>>
Cc:
[email protected]<mailto:[email protected]>
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
<[email protected]<mailto:[email protected]>> 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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