Sepsis Case Studies

Sepsis remains a frequent and deadly healthcare problem in hospitals across the United States and affects millions around the world. Despite decades of intense research and advances in technology, sepsis continues to take a heavy toll in morbidity and mortality. According to American Association of Critical Care Nurses (2010), “Mortality from sepsis is greater that breast cancer, lung cancer, and colon cancer combined and is the number one cause of death in the non-coronary ICU” (page 2). Severe sepsis has an extremely high mortality rate of 30 to 60 percent and is expected to double in the coming years (American Association of Critical Care Nurses, 2010). In about 1,118 cases at Pomona Valley Hospital Medical Center (PVHMC), it has been measured
that this facility has an actual mortality rate of 21.65% in a comparison to their predicted mortality rate of 21.26% (Healthgrades, 2016). In 2004, a consensus committee representing 11 professional organizations published the Surviving Sepsis Campaign (SSC) Guidelines for the management of severe sepsis and septic shock.
This included 47 specific graded recommendations, based on a review of the then current literature. The evidence-based therapies for patients meeting the clinical definition of severe sepsis and septic shock include initiation of appropriate antibiotics within the first hours after onset of severe systemic infection, early fluid resuscitation, corticosteroids, drotrecogin alfa (activated), strict glycemic control, and lung-protective ventilation (Dellinger et al., 2012). Although there are controversies regarding the available evidence for some of these strategies, existing recommendations for the management of patients with severe sepsis or septic shock support their use in daily practice (Nguyen et al.,
2006). With this information at hand, PVHMC has taken a particular stance in this topic and has began to develop strategies to impact the outcomes of this diagnosis.
Although identifying patients with severe sepsis is a major challenge, it can now be addressed by the strict application of evidence-based clinical practices. In 2015, PVHMC has implemented an in-house “Gold Alert” initiative that was modeled in conjunction with the Surviving Sepsis Campaign Guidelines. This alert is a collaborative team approach to provide rapid assessment and time sensitive intervention to possible septic patients based on the sepsis bundles. A Gold Alert will be called for any patient that has a known or suspected infection and had 2 or more Systemic Inflammatory Response Syndrome (SIRS) indicators. The Gold Alert system can be initiated from anywhere in the hospital. This way, treatment could be initiated regardless of where the patient is located within the hospital with the goal of achieving more successful
outcomes. PVHMC’s sepsis program which is based on the evidence-based sepsis resuscitation (6 hours) and management (24 hours) bundles were introduced via educational in services to all staff members and physicians. Despite the difficulties in translating the SSC recommendations into daily practice, research following this approach was able to demonstrate substantial survival benefits. Unfortunately, unit level data and hospital benchmarks are currently unavailable due to the fact that more current evaluations are being conducted by the hospital’s quality improvement (QI) department on the adherence to this program for the early intervention on sepsis by staff members and hospital mortality. However, “it is safe to say at this point, it is showing that the strategies developed are positively impacting patient outcomes” (Anonymous RN; QI department, personal communication, July 22, 2016).