By Angela Craig APN,MS,CCNS  Clinical Nurse Specialist of ICU at CRMC

Despite the newer or traditional definition of sepsis, severe sepsis or septic shock, evidence is clear that sepsis kills and early intervention is a way to improve outcomes. With much success, Cookeville Regional Medical Center (CRMC) has implemented a sepsis protocol for early intervention, improved outcomes and is the first hospital in Tennessee to be certified in sepsis care by the Joint Commission (TJC).

CRMC has found there are some very specific items to focus on in order to intervene appropriately. First – it is imperative that a screening process is in place. If you do not screen your patients for sepsis you will miss patients. Since the Emergency Department (ED) is a feeder to your hospital, starting first with this department makes sense. Next, or at the same time, roll out a screening process for the critical care areas. Once screenings are in place, roll this out to every inpatient unit in your hospital so that no patient is without a sepsis screen. Screening should be done for all patients upon arrival to the ED, arrival to the unit to which they are admitted, every shift and as needed (PRN). This can be done electronically or on paper.

Secondly, it is important to have a process in place to implement actions based on a positive screen. It is nice when items are protocolized so standardized practice can occur. CRMC has a process that allows nurses to order lactic acid and blood cultures per protocol if the patient meets the triggers. This is not meant to keep the provider out of the loop but is meant to expedite the interventions. The provider will then order the needed IV fluids and antibiotics and use the standing orders for sepsis. Remember always that “Time is Tissue” and early intervention is the key to better perfusion.

Thirdly, it is essential to track and know how well you are doing with your septic patient population. There should be a tracking mechanism to know what the patient outcomes are. Once gaps are identified, the appropriate provider or nurse is notified about the opportunity for better care and whether a process needs to be changed to increase compliance. If needed, this can be determined and implemented. Tracking does take manpower and it is vital that the abstractor is knowledgeable and understands exactly the elements to be reviewed and shared.

To become certified in sepsis care by TJC, there is an on-site review involving an assessment of how clinical outcomes and other performance measures are used to identify opportunities to improve care. The surveyors also look at whether the organizational leaders understand and are committed to improving the quality of care for patients in need of the services the program provides. Finally, they look at how patients and their caregivers are educated and prepared for discharge. This certification at CRMC has expanded our goals for our sepsis patients and is an avenue for meeting improved outcomes for our patients.

Implementing the sepsis protocol is hard work, but it can be done. For the last three tracking months CRMC has had a survival rate for the combined severe sepsis and septic shock patients of 94% and 95%. These results are absolutely from hard work and having processes in place for early intervention. We are serious about taking out sepsis at CRMC! Knowledge is powerful, and any education for nurses, providers, nursing assistants and all employees will make a difference.