Authors

  1. Pierotti, Danielle PhD, RN, CENP, CHPN
  2. Cardillo, Al

Abstract

Article Content

Sepsis kills more people each year than breast cancer, prostate cancer, and AIDS combined. Sepsis is the number one cause of death in hospitals and the primary driver of readmissions within 30 days (Agency for Healthcare Research and Quality, 2016). The Centers for Disease Control and Prevention (CDC) states that 80% of sepsis begins outside the hospital and 70% of patients with sepsis had recently used healthcare services or had chronic diseases requiring frequent medical care (CDC, 2016).

 

Sepsis is the body's overwhelming and life-threatening response to infection, which can lead to tissue damage, organ failure, and death. As the body responds to an infection, the immune system releases a series of chemicals, which trigger inflammation, reducing blood flow causing both clots and leaky blood vessels. Severe cases lead to septic shock marked by multiple organ failure. Sepsis is not related to any one bacteria or virus, but can occur as a result of any infection and progress to death in as little as 30 minutes in immunocompromised patients. The key to reducing death and injury from sepsis is time. Early recognition of sepsis is critical to beginning treatment and stopping the progression to organ failure.

 

Patients receiving home care are at high risk for developing sepsis. Home care patients share many of the primary risks for sepsis: over 65 years of age or medically fragile children and adults, with multiple chronic conditions, using healthcare regularly and experiencing infections of the lung, skin, urinary or gastrointestinal tract. Home healthcare agencies have an opportunity to significantly reduce morbidity and mortality by incorporating sepsis awareness into daily practice. Recognizing the need to reduce patient risk from sepsis, the Home Care Association of New York State (HCA) seized the challenge to be the first to develop sepsis tools for home healthcare.

 

The HCA Quality Committee consulted with health system leaders across New York, the State Health Department, the NYS Sepsis Advisory Committee, the Rory Staunton Foundation Board, and the National Sepsis Alliance Board. These experts reinforced the urgency of early, prehospital recognition of sepsis and encouraged HCA's work as a critical expansion of the statewide hospital protocol to manage sepsis. In 2015, the HCA Quality Committee formed a Sepsis Workgroup led by Amy Bowerman, RN, Director of Quality Improvement for Visiting Nurse Association of Utica & Oneida County, and Director of Patient Services for Senior Network Health. The workgroup drafted and tested a home healthcare screening tool and algorithm for early recognition and intervention consistent with the hospital protocol.

 

Statewide rollout of the tool is currently under way. A sequence of training webinars present the background and facts of sepsis, instructions for use of the tools, examples for integration of the tool into an agency's electronic health records, and a "train-the-trainer" session for agency clinicians. HCA plans to offer agency assistance for implementation, conduct statewide data gathering and program evaluation, and is advocating for funding to further support the program through the state budget.

 

The HCA sepsis program is an important road map for home care quality on many levels. Assertive involvement in sepsis screening and early intervention by home care agencies provide a significant opportunity to save lives, reduce the risk of severe life-altering morbidity, reduce 30-day readmission rates, improving agency quality metrics, reduce overall health costs, and improve coordination and connection across the healthcare system.

 

Further information about the HCA project, tools, and rollout is available from HCA. Agencies and associations interested in adopting the Sepsis Protocol and leading local efforts to save lives from sepsis are encouraged to contact them.

 

REFERENCES

 

Agency for Healthcare Research and Quality. 2016. Healthcare cost and utilization project, Statistical brief #204. Retrieved from http://http://www.hcup-us.ahrq.gov/reports/statbriefs/sb204-Most-Expensive-Hospital-Conditions.pdf [Context Link]

 

Centers for Disease Control and Prevention. 2016. CDC Vital signs. Retrieved from https://http://www.cdc.gov/vitalsigns/pdf/2016-08-vitalsigns.pdf [Context Link]