Readers Write: Sepsis Risk Intervention: You May Be Doing It Wrong

Sepsis Risk Intervention: You May Be Doing It Wrong
By Jennifer Knapp

Jennifer Knapp is director of strategic partnerships and solutions for Vocera of San Jose, CA.

September was Sepsis Awareness Month. Many hospitals and health systems, propelled by CMS penalties for avoidable hospital-acquired infections, have made important investments in sepsis risk intervention. But these efforts have introduced new challenges.

As nurses are put on high alert for a growing number of risk factors—including falls, drug interactions, etc.—they are struggling to attend to and prioritize all of these different alerts. For long-term success against the scourge of sepsis, the health IT industry must work to mitigate and manage the negative impact of alarm fatigue on our frontline healthcare providers.

Sepsis is an important target of hospital quality and safety programs. It is a leading cause of death in the U.S., claiming 750,000 lives annually. With $24B spent annually, it is the costliest medical condition to treat in this country. Luckily, strong evidence shows that early, tailored intervention can significantly reduce the likelihood of sepsis-related complications and death.

To this end, many hospitals have deployed EHR-based pop-up advisories to identify patients at risk for sepsis. But there are three problems:

• Nearly half of these alerts are false-positives.
• They get mixed in with the routine pop-ups nurses have learned to quickly click through.
• Nurses will only see these alerts if they are working in the EHR. Since nurses can walk up to five miles a day during a 12-hour shift, they are often away from the EHR.

Sepsis rates will not fall dramatically unless risk intervention alerts are accurate, reliable, and actionable. Alerts must give nurses the right information at the right time in the right way.

The algorithm used to detect sepsis must include nursing and provider documentation, in addition to data from the EHR, to improve the precision of risk determination. Alerts should only be delivered when they provide new information to the staff or when appropriate treatment steps have not been completed. Sending only actionable alerts will significantly reduce alarm fatigue.

Move sepsis alerts out of the routine flow of EHR notifications where they are likely to get lost in the shuffle. Instead, deliver them to caregivers on mobile devices at the point of care. The bottom line is that if you don’t use a mobile alert solution, you are leaving sepsis detection to chance because caregivers may not check the EHR for long periods of time.

Don’t just tell the nurse there’s a septic patient in Room 101. Provide more detailed information about the level of his or her condition (such as severe sepsis), why the alert was triggered (for example, hypotension), and what to do next. Consider functionality that would automatically alert another group, such as the rapid response team, after the alert is accepted by the frontline nurse on duty.

Hospitals are more committed than ever to reduce sepsis rates and intervene early to save lives. Health IT solutions should support, not stymie, these efforts. Deploying the right workflows and technology, driving care team engagement, and managing performance improvement against goals are keys to a successful sepsis program. Do it right and you can significantly improve patient outcomes.