Dr. Westover - AMEN
Isn't it a physician's job to know about changes in vital signs, mental status, or organ function? There is something seriously wrong with some of these people. They deserve early diagnosis and treatment whether it's sepsis or not. If we welcome rather than resist reporting, we'll miss fewer of these opportunities. Ron Elkin, MD Pulmonary/Critical Care California Pacific Medical Center San Francisco On Mon, Nov 27, 2017 at 5:33 PM, Thomas Westover <twest54...@yahoo.com> wrote: > 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, FACOG > Asst Professor MFM and Obgyn > Cooper Medical School, Rowan University > Vice Chair, NJ ACOG > Co-Chair, NJ Hospital Association Statewide Perinatal Safety Collaborative > Camden NJ > > > ------------------------------ > *From:* "sepsisgroups-requ...@lists.sepsisgroups.org" < > sepsisgroups-requ...@lists.sepsisgroups.org> > *To:* sepsisgroups@lists.sepsisgroups.org > *Sent:* Monday, November 27, 2017 12:49 PM > *Subject:* Sepsisgroups Digest, Vol 270, Issue 1 > > Send Sepsisgroups mailing list submissions to > sepsisgroups@lists.sepsisgroups.org > > To subscribe or unsubscribe via the World Wide Web, visit > http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups- > sepsisgroups.org > > or, via email, send a message with subject or body 'help' to > sepsisgroups-requ...@lists.sepsisgroups.org > > You can reach the person managing the list at > sepsisgroups-ow...@lists.sepsisgroups.org > > When replying, please edit your Subject line so it is more specific > than "Re: Contents of Sepsisgroups digest..." > > > 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" > <barne...@sutterhealth.org> > To: "Orth, Claudia" <cor...@mhc.net>, jenny clarke <j...@live.com>, > "Tara Miller" <tara.mil...@infirmaryhealth.org> > Cc: "sepsisgroups@lists.sepsisgroups.org" > <sepsisgroups@lists.sepsisgroups.org> > Subject: Re: [Sepsis Groups] [**External**] Re: Sepsis Best Practice > Alerts > Message-ID: > <DM5PR11MB1372A81FF4E069CE10B616E1F32F0@DM5PR11MB1372. > namprd11.prod.outlook.com> > > Content-Type: text/plain; charset="utf-8" > > 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 <(916)%20200-5604>| barne...@sutterhealth.org<mailto: > barne...@sutterhealth.org> > > ?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:sepsisgroups-boun...@lists.sepsisgroups.org] > On Behalf Of Orth, Claudia > Sent: Wednesday, November 15, 2017 12:50 PM > To: jenny clarke <j...@live.com>; Tara Miller < > tara.mil...@infirmaryhealth.org> > Cc: sepsisgroups@lists.sepsisgroups.org > Subject: [**External**] Re: [Sepsis Groups] Sepsis Best Practice Alerts > > > WARNING: This email originated outside of the Sutter Health email system! > DO NOT CLICK links if the sender is unknown and never provide your User ID > or Password. > > > > 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 <(231)%20935-5692> > 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.miller@ > infirmaryhealth.org>> > Cc: sepsisgroups@lists.sepsisgroups.org<mailto:sepsis > gro...@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. 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. > > _______________________________________________ > Sepsisgroups mailing list > Sepsisgroups@lists.sepsisgroups.org<mailto:Sepsis > gro...@lists.sepsisgroups.org> > http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org< > https://na01.safelinks.protection.outlook.com/?url=https%3A%2F% > 2Furldefense.proofpoint.com%2Fv2%2Furl%3Fu%3Dhttp-3A__ > lists.sepsisgroups.org_listinfo.cgi_sepsisgroups-2Dsepsisgroups.org%26d% > 3DDwMGaQ%26c%3DNjMSpGk2_ZA7ZXEWULsqPkmhl_68_j_HpnUZ-YvUJ78%26r%3Ddtp2T- > Kko33TS6Sl7iEnNQ%26m%3DpzBF6Z5vMsDHrM3dYRv9FeX34bt0QSxdwK1I0pue5Po%26s% > 3DlX53IuJ5hVpPpzFVXRCM4VijMOFoVWdCb6grvu1UGt4%26e%3D&data= > 02%7C01%7Cbarnesm4%40sutterhealth.org%7C860c98ee853f4180df6f08d52dc7ee49% > 7Caef453eadaa243e0be62818066e9ff63%7C0%7C0%7C636465259086704926&sdata= > uYvI1XJxoy7cbEB7bynGNPPAwu1BrwuAo%2BiiY5jiVNk%3D&reserved=0> > -------------- next part -------------- > An HTML attachment was scrubbed... > URL: <http://lists.sepsisgroups.org/pipermail/sepsisgroups- > sepsisgroups.org/attachments/20171117/0e9f7116/attachment.html> > -------------- next part -------------- > A non-text attachment was scrubbed... > Name: image001.jpg > Type: image/jpeg > Size: 3990 bytes > Desc: image001.jpg > URL: <http://lists.sepsisgroups.org/pipermail/sepsisgroups- > sepsisgroups.org/attachments/20171117/0e9f7116/attachment.jpg> > > ------------------------------ > > Subject: Digest Footer > > _______________________________________________ > Sepsisgroups mailing list > Sepsisgroups@lists.sepsisgroups.org > http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org > > > ------------------------------ > > End of Sepsisgroups Digest, Vol 270, Issue 1 > ******************************************** > > > > _______________________________________________ > Sepsisgroups mailing list > Sepsisgroups@lists.sepsisgroups.org > http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org > >
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