Very well said.
ER ________________________________ From: Sepsisgroups <sepsisgroups-boun...@lists.sepsisgroups.org> on behalf of Ron Elkin <elkin....@gmail.com> Sent: Wednesday, November 29, 2017 11:10 PM To: Thomas Westover Cc: sepsisgroups@lists.sepsisgroups.org Subject: Re: [Sepsis Groups] Sepsisgroups Digest, Vol 270, Issue 1 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<mailto: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<mailto:sepsisgroups-requ...@lists.sepsisgroups.org>" <sepsisgroups-requ...@lists.sepsisgroups.org<mailto:sepsisgroups-requ...@lists.sepsisgroups.org>> To: sepsisgroups@lists.sepsisgroups.org<mailto: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<mailto:sepsisgroups@lists.sepsisgroups.org> To subscribe or unsubscribe via the World Wide Web, visit http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org<https://urldefense.proofpoint.com/v2/url?u=http-3A__lists.sepsisgroups.org_listinfo.cgi_sepsisgroups-2Dsepsisgroups.org&d=DwMFaQ&c=aLnS6P8Ng0zSNhCF04OWImQ_He2L69sNWG3PbxeyieE&r=u3-hP_Lx4IJRZpEo3GaVKbKv9GjffxKt86wx73wzxyw&m=StiP7XkzoISfbJv_o0Sr4HKZaLOfu__JCXpVMUvD3a8&s=BFX2kQ-eUcYVlUBcgcyiuwrErskKZ2hmrngfSyWgxgQ&e=> or, via email, send a message with subject or body 'help' to sepsisgroups-requ...@lists.sepsisgroups.org<mailto:sepsisgroups-requ...@lists.sepsisgroups.org> You can reach the person managing the list at sepsisgroups-ow...@lists.sepsisgroups.org<mailto: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<mailto:barne...@sutterhealth.org>> To: "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>" <sepsisgroups@lists.sepsisgroups.org<mailto:sepsisgroups@lists.sepsisgroups.org>> Subject: Re: [Sepsis Groups] [**External**] Re: Sepsis Best Practice Alerts Message-ID: <dm5pr11mb1372a81ff4e069ce10b616e1f3...@dm5pr11mb1372.namprd11.prod.outlook.com<mailto:dm5pr11mb1372a81ff4e069ce10b616e1f3...@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<tel:(916)%20200-5604>| barne...@sutterhealth.org<mailto:barne...@sutterhealth.org><mailto: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<https://urldefense.proofpoint.com/v2/url?u=https-3A__newsplus.sutterhealth.org_peninsula-2Dcoastal_files_2017_04_SH-5FPride-5FPlus400-2D002-2D177x177.gif&d=DwMFaQ&c=aLnS6P8Ng0zSNhCF04OWImQ_He2L69sNWG3PbxeyieE&r=u3-hP_Lx4IJRZpEo3GaVKbKv9GjffxKt86wx73wzxyw&m=StiP7XkzoISfbJv_o0Sr4HKZaLOfu__JCXpVMUvD3a8&s=7qoV5g5jyMQhq_XQ_XaeooDs-Pm0yClW87iFyL8iZ_U&e=>] From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org<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<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: [**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<tel:(231)%20935-5692> cor...@mhc.net<mailto:cor...@mhc.net><mailto:cor...@mhc.net<mailto:cor...@mhc.net>> From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org<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><mailto:tara.mil...@infirmaryhealth.org<mailto:tara.mil...@infirmaryhealth.org>>> Cc: sepsisgroups@lists.sepsisgroups.org<mailto:sepsisgroups@lists.sepsisgroups.org><mailto: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><mailto: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. 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