Sepsis Team Saving Lives Thanks to Specialized Training and Education
uality healthcare in the 21st Century, more than ever before, requires a multi-disciplinary approach to achieve the best outcomes for patients. A noteworthy example of Community Memorial Health System’s successful “Commitment to Caring” through this team effort is the recent strides made battling sepsis. Sepsis is a serious and potentially lifethreatening condition that occurs when natural chemicals released in a person’s bloodstream to fight an infection actually trigger inflammation throughout the body and cause complications. This can lead to a cascade of serious health events, including damage to organs and even failure. Each year sepsis strikes an estimated 750,000 people nationally. Furthermore, sepsis is the leading cause of death for non-cardiac, critically ill patients in hospitals in the United States. 12
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However, at Community Memorial Hospital and Ojai Valley Community Hospital there has been a significant decrease in the mortality rate due to sepsis. Indeed, CMHS physicians, nurses and staff are at the vanguard of sepsis care nationwide thanks to a redoubled emphasis on specialized training and education. Two years ago, the Institute for Healthcare Improvement recommended that all U.S. hospitals renew their focus on early diagnosis of sepsis. The result has been positive with the national mortality rate falling to 29 percent. Impressively, CMHS’s mortality figure for sepsis is 63 percent better the national average, dropping from an already superb 15 percent over this time frame to 10.9 percent today. “We are proud of the statistical progress,” says Cindy DeMotte, CMH Vice President of Quality.” But what’s even more important is
that our improvement means another eight or nine lives are saved each year. That’s the ultimate gift our Sepsis Team is giving.” Instrumental to this gift of lives saved was a gift by longtime benefactor, Carol Hambleton, with her generosity designated towards infection control and fighting sepsis. (Read more about Carol Hambleton in the accompanying story “ I See This As My Way To Contribute” on page 15.) CMHS’s bolstered energies in this area began two years ago when Dr. Amir Arfaei, a pulmonologist; Dr. Deborah Carlson, a hospitalist; Dr. David Lebell, emergency department physician; and Helen Thompson, nurse educator for critical care
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We are extremely proud that our success with sepsis is much, much better than the national average.”
and telemetry, began establishing updated orders and protocols for indentifying and treating sepsis. Concurrently, nurses from every floor in the hospital – more than a dozen in all – were selected to attend a training conference on sepsis delivered by the Hospital Association of Southern California For Patient Safety. “The nurses came back really energized about working on this problem,” recalls Cynthia Fahey, clinical quality coordinator at CMH. “Their enthusiasm was infectious and got everyone else on board our sepsis campaign,” adds Marsha Parker, director of quality at CMH. Working hand-in-hand with CMH’s Quality
Committee, a “Sepsis Team” was created that included physicians, nurses and managers. Goals included establishing and implementing updated guidelines and protocols. Equally important was simultaneously expanding specialized education and training throughout the hospital. To this end, in 2013, ten teams consisting of six healthcare workers each were formed with representatives from all departments in CMH and OVCH. Indeed, while sepsis is most common in emergency departments and intensive care units, CMHS made it a priority to involve all departments and personnel in the educational and training processes.
These 60 employees then received state-ofthe-art training in a high-tech simulation van, which was made possible by Carol Hambleton’s financial largess. “Her timely donation was really instrumental in making the Sim Van possible and moving our efforts forward,” praises Thompson. “The van was extremely helpful,” echoes Dr. Anthony Hernandez, emergency department physician at CMH. As the director of sepsis at CMHS, Dr. Hernandez has coordinated a multi-disciplinary leadership group of talented Continued on next page COMMUNITY MEMORIAL HEALTH SYSTEM | CARING
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We are all pretty excited about our progress and results. It’s rewarding to know this is making a difference with our patients.” physicians including Dr. Arfaei, Dr. Carlson, Dr. Lebell and Dr. Henry Oster, infectious disease. The simulation van features a human-like mannequin with sophisticated computer software designed to improve individual and team skills in recognizing the early stages of sepsis by offering a wide variety of realistic scenarios. This hands-on training has been proven to optimize clinical outcomes. A key component of CMHS’s approach to simulation training was having the physicians and nurses routinely switch roles.” This interaction allowed them to experience things from the other’s viewpoint and this in turn improved their communication and synchronization,” Fahey explains.” Having the physicians and nurses understand each other better has taken our practices to an even higher level.”
Additional education included eight hours of online courses, tests and follow-up seminars. But the learning has not stopped there. The next step was having the “students” who went through the simulation course become “teachers” to their colleagues throughout CMHS. “In this way the protocols are now known by everyone in the hospital,” notes DeMotte. “Education is key,” agrees Thompson.” CMHS is dedicated to this effort and the continuous learning required.” To this end, more employees continue to periodically receive invaluable simulation van training. Contrary to common perception by the general public, patients often already have sepsis before they arrive at a hospital and do not contract it after being admitted. Rather, sepsis frequently “presents” in the hospital because a patient is already in a fragile condition. “Once sepsis presents,” Parker further explains, “especially when a patient is in a fragile state, health issues can cascade.” Indeed, while anyone can develop sepsis, it is most common – and most dangerous – in the elderly, the very young, and those with weakened immune systems. Patients with pneumonia, urinary infections or diabetes are especially at high risk of serious complications when sepsis strikes. Others at high risk include those who have invasive devices, such as intravenous catheters or breathing tubes. “Sepsis poses a special challenge because the nature of the beast of this disease is that it is not easily identified,” explains Dr. Hernandez, noting that its signs and symptoms can also be caused
by numerous other disorders.” The early stages are not at all obvious – you really need to have your radars on high alert.” “Nurses are at the forefront,” Dr. Hernandez continues.” Because they are with the patients more continuously, nurses are in a better position to hopefully identify sepsis sooner and then react quickly with intervention.” “The ‘Rule of 100s’ has helped greatly in our early recognition,” adds Fahey, explaining that this means being on the watch for a heart rate over 100; body temperature over 100; and blood pressure under 100.” All three 100s are not always present, however, which adds to the difficulty of diagnosis.” Once diagnosed, new protocols designed by Dr. Hernandez and his fellow Sepsis Team physicians include a “three-hour bundle” of treatment as well as a concurrent “six-hour bundle.” The results, as mentioned, have already been outstanding. “We are extremely proud that our success with sepsis is much, much better than the national average,” says Parker, while Thompson echoes: “I’m proud of the more robust sepsis program we have developed.” But CMHS is not resting on its laurels.” Continuing the education and training of our staff is an ongoing effort,” DeMotte points out.” We are always looking to enhance our care.” “We have had a great response from the medical staff and strong support throughout the hospital,” Dr. Hernandez says.” We are all pretty excited with our progress and results. It’s rewarding to know this is making a difference with our patients.”
Sixty hospital employees received state-of-the-art training in a high-tech simulation van.
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