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<p class="MsoNormal"><span style="color:#1F497D">At Sutter Health we have several:
<o:p></o:p></span></p>
<p class="MsoNormal"><span style="color:#1F497D">First is “possible sepsis” for Infection (active culture, problem list) plus
<i>available </i>SIRS<o:p></o:p></span></p>
<p class="MsoNormal"><span style="color:#1F497D">Second is “possible severe sepsis” – same as above plus
<i>available</i> organ dysfunction (excludes BUN/Cr for example for ESRD)<o:p></o:p></span></p>
<p class="MsoNormal"><span style="color:#1F497D">Third is “possible septic shock” - above with Lactate
<u>></u> 4<o:p></o:p></span></p>
<p class="MsoNormal"><span style="color:#1F497D"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="color:#1F497D">1 and 2 fire only for RNs 3 fires for RN, and providers<o:p></o:p></span></p>
<p class="MsoNormal"><span style="color:#1F497D"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="color:#1F497D">We are moving toward predictive analytics(PA) – and may or may not continue with BPAs – or just go to PA alerts where the recipient doesn’t need to be in the chart to be notified, as with a BPA<o:p></o:p></span></p>
<p class="MsoNormal"><span style="color:#1F497D"><o:p> </o:p></span></p>
<div>
<p class="MsoNormal"><b><span style="font-size:10.0pt;font-family:"Arial",sans-serif;color:#1F497D">Thanks,
<o:p></o:p></span></b></p>
<p class="MsoNormal"><b><span style="font-size:10.0pt;font-family:"Arial",sans-serif;color:#00A19C"><o:p> </o:p></span></b></p>
<p class="MsoNormal"><b><span style="font-size:10.0pt;font-family:"Arial",sans-serif;color:#00A19C">MARY ANN BARNES-DALY
</span></b><b><span style="font-size:8.0pt;font-family:"Arial",sans-serif;color:#00A19C">MS RN CCRN DC</span></b><span style="font-size:10.0pt;font-family:"Arial",sans-serif;color:#365F91">
</span><span style="font-size:10.0pt;font-family:"Arial",sans-serif;color:#1D1B11">|</span><span style="font-size:10.0pt;font-family:"Arial",sans-serif;color:#365F91">
</span><b><span style="font-size:10.0pt;font-family:"Arial",sans-serif;color:gray">Clinical Performance Improvement Consultant</span></b><span style="font-size:10.0pt;font-family:"Arial",sans-serif;color:#365F91"><o:p></o:p></span></p>
<p class="MsoNormal"><b><i><span style="font-size:10.0pt;font-family:"Arial",sans-serif;color:#1F497D">Quality & Clinical Effectiveness Team
</span></i></b><b><i><span style="font-size:10.0pt;font-family:"Arial",sans-serif;color:#E36C0A">|</span></i></b><i><span style="font-size:10.0pt;color:#1F497D">
</span></i><b><i><span style="font-size:10.0pt;font-family:"Arial",sans-serif;color:#1F497D">Office of Patient Experience</span></i></b><b><i><span lang="EN" style="font-size:10.0pt;font-family:"Arial",sans-serif;color:#1F497D"><o:p></o:p></span></i></b></p>
<p class="MsoNormal"><b><i><span lang="EN" style="font-size:10.0pt;font-family:"Arial",sans-serif;color:#1F497D">Sutter Health -</span></i></b><i><span lang="EN" style="font-size:10.0pt;font-family:"Arial",sans-serif;color:#1F497D">2200 River Plaza Drive, Sacramento,
CA 95833<b><o:p></o:p></b></span></i></p>
<p class="MsoNormal"><span style="font-size:10.0pt;font-family:"Arial",sans-serif;color:#1F497D">Mobile 916.200.5604</span><b><span style="font-family:"Arial",sans-serif;color:#00A19C">|
<a href="mailto:barnesm4@sutterhealth.org"><span style="color:#0563C1">barnesm4@sutterhealth.org</span></a>
<o:p></o:p></span></b></p>
<p class="MsoNormal"><i><span style="color:#1F497D"><o:p> </o:p></span></i></p>
<p class="MsoNormal"><span style="font-family:"Garamond",serif;color:#1F497D">“Do the best you can until you know better. Then when you know better, do better” Maya Angelou
</span><span style="font-size:12.0pt;font-family:"Garamond",serif;color:#1F497D"><o:p></o:p></span></p>
<p class="MsoNormal"><span style="color:#1F497D"><img border="0" width="133" height="133" id="Picture_x0020_1" src="cid:image001.jpg@01D35F7B.8E4F3C90" alt="https://newsplus.sutterhealth.org/peninsula-coastal/files/2017/04/SH_Pride_Plus400-002-177x177.gif"></span><span style="color:#1F497D"><o:p></o:p></span></p>
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<p class="MsoNormal"><span style="color:#1F497D"><o:p> </o:p></span></p>
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<p class="MsoNormal"><b>From:</b> Sepsisgroups [mailto:sepsisgroups-bounces@lists.sepsisgroups.org]
<b>On Behalf Of </b>Orth, Claudia<br>
<b>Sent:</b> Wednesday, November 15, 2017 12:50 PM<br>
<b>To:</b> jenny clarke <jbc1@live.com>; Tara Miller <tara.miller@infirmaryhealth.org><br>
<b>Cc:</b> sepsisgroups@lists.sepsisgroups.org<br>
<b>Subject:</b> [**External**] Re: [Sepsis Groups] Sepsis Best Practice Alerts<o:p></o:p></p>
</div>
</div>
<p class="MsoNormal"><o:p> </o:p></p>
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<p style="margin-top:0in"><strong><span style="font-size:9.0pt;font-family:"Arial",sans-serif;color:maroon">WARNING:
</span></strong><span style="font-size:9.0pt;font-family:"Arial",sans-serif;color:#666666">This email originated outside of the Sutter Health email system!<br>
</span><strong><span style="font-size:9.0pt;font-family:"Arial",sans-serif;color:maroon">DO NOT CLICK</span></strong><span style="font-size:9.0pt;font-family:"Arial",sans-serif;color:#666666"> links if the sender is unknown and never provide your User ID or
Password. <o:p></o:p></span></p>
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<p class="MsoNormal" style="margin-bottom:12.0pt"><span style="font-size:12.0pt;font-family:"Times New Roman",serif"><o:p> </o:p></span></p>
<div>
<p class="MsoNormal"><span style="color:#1F497D">Would you be able to share what criteria is used to fire the Best Practice Alert (BPA). We currently have 2 alerts that fire: 1 for SIRS and 1 for SIRS PLUS organ dysfunction. We are thinking of blending the
2 together to perhaps give them a bit more sensitivity and specificity thereby decreasing some of the confusion and “alert fatigue” we are experiencing.
<o:p></o:p></span></p>
<p class="MsoNormal"><span style="color:#1F497D"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="color:#1F497D">I am desperately seeking input and feedback on how other institutions have addressed this…i.e. what criteria triggers and alert, what is the response, is the alert sent out as a page or an open chart alert, etc.
There is still reluctance to have “alerts” go to providers so nursing currently carries the full burden of these.
<o:p></o:p></span></p>
<p class="MsoNormal"><span style="color:#1F497D"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="color:#1F497D">Our thought is to have an alert fire to nursing that would require a call to the provider if the following is present. Please feel free to critique and advise:<o:p></o:p></span></p>
<p class="MsoNormal"><span style="color:#1F497D"><o:p> </o:p></span></p>
<p class="MsoNormal"><b><span style="color:black">3/6 of the below criteria is present = EARLY WARNING ALERT FIRES<o:p></o:p></span></b></p>
<p class="MsoListParagraphCxSpFirst" style="text-indent:-.25in;mso-list:l0 level1 lfo2">
<![if !supportLists]><span style="color:black"><span style="mso-list:Ignore">1.<span style="font:7.0pt "Times New Roman"">
</span></span></span><![endif]><span style="color:black">HR > 90<o:p></o:p></span></p>
<p class="MsoListParagraphCxSpMiddle" style="text-indent:-.25in;mso-list:l0 level1 lfo2">
<![if !supportLists]><span style="color:black"><span style="mso-list:Ignore">2.<span style="font:7.0pt "Times New Roman"">
</span></span></span><![endif]><span style="color:black">RR>20<o:p></o:p></span></p>
<p class="MsoListParagraphCxSpMiddle" style="text-indent:-.25in;mso-list:l0 level1 lfo2">
<![if !supportLists]><span style="color:black"><span style="mso-list:Ignore">3.<span style="font:7.0pt "Times New Roman"">
</span></span></span><![endif]><span style="color:black">Temp >38.5 or <36.0<o:p></o:p></span></p>
<p class="MsoListParagraphCxSpMiddle" style="text-indent:-.25in;mso-list:l0 level1 lfo2">
<![if !supportLists]><span style="color:black"><span style="mso-list:Ignore">4.<span style="font:7.0pt "Times New Roman"">
</span></span></span><![endif]><span style="color:black">WBC >12,000 or <4,000 or Bands >10%<o:p></o:p></span></p>
<p class="MsoListParagraphCxSpMiddle" style="text-indent:-.25in;mso-list:l0 level1 lfo2">
<![if !supportLists]><span style="color:black"><span style="mso-list:Ignore">5.<span style="font:7.0pt "Times New Roman"">
</span></span></span><![endif]><span style="color:black">Altered Level of Consciousness<o:p></o:p></span></p>
<p class="MsoListParagraphCxSpLast" style="text-indent:-.25in;mso-list:l0 level1 lfo2">
<![if !supportLists]><span style="color:black"><span style="mso-list:Ignore">6.<span style="font:7.0pt "Times New Roman"">
</span></span></span><![endif]><span style="color:black">SBP <90<o:p></o:p></span></p>
<p class="MsoNormal"><b><span style="color:black">→Nurses order STAT Lactate level & the notify the Provider who needs to assess the patient and document why sepsis is being r/o
<i><u>or</u></i> begin sepsis orders – 3 hour bundle. This will also offload the current burden of nursing needing to decipher whether or not infection is present or should be suspected.
</span><span style="color:#1F497D"><o:p></o:p></span></b></p>
<p class="MsoNormal"><span style="color:black"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="color:black">*? Blends Sepsis 2 and Sepsis 3 definitions
<b><u>and</u></b> streamlines/simplifies expected standard of care/roles & responsibilities. Similar to a Modified Early Warning Score?<o:p></o:p></span></p>
<p class="MsoNormal"><span style="color:black"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="color:#2F5597">Thank you in advance for your much valued time, expertise, and anything you may be willing and able to share!<o:p></o:p></span></p>
<p class="MsoNormal"><span style="color:#2F5597"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="color:#2F5597">Sincerely, <o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:18.0pt;font-family:"Edwardian Script ITC";color:#002060">Claudia
<o:p></o:p></span></p>
<p class="MsoNormal"><span style="color:#1F497D">Claudia Orth BSN, RN , CCRN-K<o:p></o:p></span></p>
<p class="MsoNormal"><span style="color:#1F497D">Regional Sepsis Coordinator<o:p></o:p></span></p>
<p class="MsoNormal"><span style="color:#1F497D">Clinical Quality<o:p></o:p></span></p>
<p class="MsoNormal"><span style="color:#1F497D">Munson Medical Center<o:p></o:p></span></p>
<p class="MsoNormal"><span style="color:#1F497D">Traverse City, Michigan<o:p></o:p></span></p>
<p class="MsoNormal"><span style="color:#1F497D">231-935-5692<o:p></o:p></span></p>
<p class="MsoNormal"><span style="color:#1F497D"><a href="mailto:Corth1@mhc.net"><span style="color:#0563C1">Corth1@mhc.net</span></a><o:p></o:p></span></p>
<p class="MsoNormal"><span style="color:#1F497D"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="color:#1F497D"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="color:#2F5597"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="color:#1F497D"><o:p> </o:p></span></p>
<div>
<div style="border:none;border-top:solid #E1E1E1 1.0pt;padding:3.0pt 0in 0in 0in">
<p class="MsoNormal"><b>From:</b> Sepsisgroups [<a href="mailto:sepsisgroups-bounces@lists.sepsisgroups.org">mailto:sepsisgroups-bounces@lists.sepsisgroups.org</a>]
<b>On Behalf Of </b>jenny clarke<br>
<b>Sent:</b> Monday, November 06, 2017 3:25 PM<br>
<b>To:</b> Tara Miller <<a href="mailto:tara.miller@infirmaryhealth.org">tara.miller@infirmaryhealth.org</a>><br>
<b>Cc:</b> <a href="mailto:sepsisgroups@lists.sepsisgroups.org">sepsisgroups@lists.sepsisgroups.org</a><br>
<b>Subject:</b> Re: [Sepsis Groups] Sepsis Best Practice Alerts<o:p></o:p></p>
</div>
</div>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal" style="margin-bottom:12.0pt">We set it up to not fire again once cleared by the nurse. But it will still fire for Dr and residents. Then ever 8 hours it reset. But I will say I am not sure it is helping. We did add GCS score to take into
account neuro status. But it is still very hard to get nurses on floor to enter that with all vital signs. Still a struggle!!<span style="font-size:12.0pt"><o:p></o:p></span></p>
<div id="AppleMailSignature">
<p class="MsoNormal">Sent from my iPhone<o:p></o:p></p>
</div>
<div>
<p class="MsoNormal" style="margin-bottom:12.0pt"><br>
On Nov 6, 2017, at 1:42 PM, Tara Miller <<a href="mailto:tara.miller@infirmaryhealth.org">tara.miller@infirmaryhealth.org</a>> wrote:<o:p></o:p></p>
</div>
<blockquote style="margin-top:5.0pt;margin-bottom:5.0pt">
<div>
<p class="MsoNormal"><span style="font-family:"Lucida Sans Unicode",sans-serif">We use EPIC as our EMR. We currently are using best practice alerts to fire off to the nursing staff when a patient meets SIRS criteria and then we have the nurse assess the patient
and review the record for possible source of infection prior to initiating the sepsis code/ alert.
</span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-family:"Lucida Sans Unicode",sans-serif"> </span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-family:"Lucida Sans Unicode",sans-serif">Does anyone else use best practice alerts and use something other than SIRS criteria? We would like to make the alert more specific and cut down on all the firings throughout the
day. </span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-family:"Lucida Sans Unicode",sans-serif"> </span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-family:"Lucida Sans Unicode",sans-serif">Thanks.
</span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-family:"Lucida Sans Unicode",sans-serif"> </span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:12.0pt;font-family:"Lucida Sans Unicode",sans-serif">Tara R Miller, RN
</span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:12.0pt;font-family:"Lucida Sans Unicode",sans-serif">Team Leader, Quality Management</span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:12.0pt;font-family:"Lucida Sans Unicode",sans-serif">Mobile Infirmary Medical Center</span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:12.0pt;font-family:"Lucida Sans Unicode",sans-serif">Office: 435-5109</span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:12.0pt;font-family:"Lucida Sans Unicode",sans-serif">Cell: 605-8270</span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:12.0pt;font-family:"Georgia",serif"> </span><o:p></o:p></p>
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