The Rapid Response/Sepsis Innovations Team at MedStar Washington Hospital Center in Washington, D.C., consists of nurses, physicians, and information systems specialists who are part of MI2, our Corporate Innovations group. By providing a better way to identify, qualify and quantify patients who are in the early stages of sepsis, this team’s hope was that early intervention would lead to better outcomes.
In an effort to provide clinicians with an instrument to flag patients who are of concern, the team developed a computer-based tool that utilizes clinical decision-making algorithms, nursing theory, knowledge and judgment combined with an ambient alert system. The system utilizes the current Rapid Response and Systemic Inflammatory Response Syndrome (SIRS)/sepsis criteria, with the evidenced-based standard early warning system criteria, resulting in a new scoring system called M2Sews, to develop the algorithms that identify patients at risk for sepsis or needing a rapid response intervention.
Starting the Research
Ambient screens were deployed to alert nurses on the rapid response team and the med/surg units. As part of their workflow, the rapid response nurses monitor an ambient screen in their office containing all hospital inpatients. The screen prioritizes the patients based on their M2Sews score and sepsis criteria. When the nurse responder identifies a patient at risk, she goes to the bedside, consults with the patient’s nurse and initiates treatment with either the patient’s primary physician or the rapid response physician. The nurse responder’s ambient screen displays all patients who scored three or greater using the M2Sews criteria. Their screen then identifies and prioritizes the patients based on the actual M2SEWS score.
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The nurses on the unit also have a heat-map display that assists them in identifying “at risk” patients using the hospital’s sepsis protocol and provides triggers based on patient vital signs and lab values. The floor nurse sees a yellow box directing them to increase the vitals to every four hours if the patients M2Sews score is one. If the M2Sews score is a two, the patient’s box is orange and reads assess for RRT. If the M2Sews score is three, the box on the ambient display is red and reads Call RRT. This screen allows every member of the team to view the SEWS scores and take action.
CREATING A SAFETY NET: Healthcare providers developed an innovative computer-based tool to identify early stages of sepsis in their patients. Kyle Kielinski/thanks to MedStar Washington Hospital Center, Washington, D.C.
The screen also alerts the nurses when the patient has screened positive for SIRS and queries her regarding a source of sepsis. If the nurse enters a “Yes” to the question of infection, the screen walks the nurse through the sepsis protocol by directing them to draw a lactate. If the lactate is > 2, an alert instructs the nurse to escalate the result to the patient’s physician or call an RRT.
Valuable Safety Net
Over the past seven months, the rapid response nurses have screened nearly 2,000 patients using the new tool. From this proactive screening and their use of the Amalga tool and ambient screen, the rapid response nurse frequently goes to the patient’s bedside and intervenes. Of the 862 patients who had interventions at the bedside, 99 of those patients were transferred to a higher level or care and/or had a rapid response call at the bedside. The rapid response nurses’ also provided 136 bedside educational sessions to staff regarding critical assessment and intervention related to sepsis. These patients were caught through an innovative safety net tool.
Patricia McCabe is clinical nursing supervisor, Janet Thorne is director, Nurse Responder Team, Nursing Supervisors and The Biocontainment Unit, and Suzanne Wilson is Integration Coordinator | MI2 Center for Digital Health and Data Science, at MedStar Washington Hospital Center, Washington, D.C.