Sepsis Alert and Importance of Rapid Treatment for Sepsis Patients
Brooke Blackstock
Delaware Technical Community College

Sepsis remains a huge source of morbidity and mortality in the United States. Although, the mortality rate from severe sepsis was noted to decrease from 39% in 2000 to 27% in 2007 in the United States, more patients required discharge to a long-term care facility. (Kumar, et al., 2011) Due to it’s high morbidity and mortality rate along with the cost for prolonged treatments a number of efforts have now been directed towards improving patient outcomes. Early intervention/treatment for patients suspected of shock is crucial in order to ensure the optimal outcome for the patient.
“Early-goal directed” therapy such as patient specific sepsis bundles ordered by physicians, as well as standardized sepsis order sets has been consistently shown improvement in areas such as: time to antibiotics, time to fluid resuscitation, lactate clearance, and mortality. Ensuring that the administration of the appropriate broad-spectrum antibiotics is another important factor that has also decreased mortality. (Hayden, et al., 2016)
In order to recognize the need for these interventions in a timely manner, the sepsis alert or “best practice alert” system is implemented into the electronic charting systems used by the facility. This alert system is programed into the hospital’s patient charting system to screen each electronic medical record for patients presenting with sepsis criteria (systolic blood pressure: >90mmHg, heart rate: >90bpm, respiratory rate: >20bpm, temperature: >38C or <36C, with a suspected or known infection) (Hayden, et al., 2016). Once a patient falls into the sepsis criteria the sepsis alert system then generates a “pop-up screen” alerting the nurse to the need for immediate communication with the physician. The activation of the Sepsis Workup and Treatment Protocol (SWAT) is left at the digression of the physician following a patient assessment. If the SWAT protocol is activated the alert system then generates a new “pop-up window” with the specific orders set entered in by the physician or “sepsis bundle.” (Figure 1 shows an example of the SWAT order set activation page for two different scenarios.) This notification pops up for all healthcare team members that are or could be in relation to the affected patient. This type of system forces the entire healthcare team to become aware of the status of the affected patient and encourages more thorough monitoring of the patient and more rapid treatment such as fluid resuscitation and antibiotic treatment for patients admitted with suspected sepsis, severe sepsis, or septic shock.
Figure 1:

References
Hayden, G. E., Tuuri, R. E., Scott, R., Losek, J. D., Blackshaw, A. M., Schoenling, A. J., . . . Hall, G. A. (2016, January). Triage sepsis alert and sepsis protocol lower times to fluids and antibiotics in the ED.. American Journal of Emergency Medicine , 34(1), 1-9.
Kumar, G., Kumar, N., Taneja, A., Kaleekal, T., Tarima, S., McGinley, E., . . . Nanchal, R. (2011, November). Nationwide Trends of Severe Sepsis in the 21st Century (2000–2007). Chest, 140(5), 1223-1231.