New Sepsis Screening Algorithm

A new sepsis screening algorithm is coming soon (go live date of Aug. 4) for the PICU and inpatient units (CVICU and NICU not included). Please Click Here to view a quick slide deck about this sepsis algorithm and earn 0.5 hours of CME ethics credit if you complete the evaluation at the end.

You can access the Inpatient Sepsis Algorithm Here. Here are the high points about this new algorithm:

Why were updates to our sepsis screening algorithm made?

Delayed or missed sepsis alerts have the potential to impact patient care.
Sepsis alerts were sometimes overcalled due to false positives (usually due to the systolic BP being just below the algorithm parameters).
Sometimes physicians or APPs were called to the bedside and instructed nursing staff not to call a sepsis alert even though it was indicated.
Overcalled sepsis alerts have the potential to create alarm fatigue.

Why are sepsis alerts important?

Effective screening can lead to important early interventions such as IV fluids and antibiotics, leading to decreased morbidity and mortality.
The goal is to reduce morbidity and mortality by reducing false sepsis alert calls and achieving >90% of appropriate sepsis alert calls.

When will a sepsis alert be called on your patients in the hospital?

If a patient has a confirmed organ dysfunction (OD) score of 2 and a change in status*
If a patient has a confirmed organ dysfunction (OD) score of ≥ 3 that is new for the patient during the last 24 hours
If a patient has a confirmed organ dysfunction (OD) score of ≥ 3 that is not new for the patient during the last 24 hours, but there is also a change in status*

*A change in status entails any of the below:

A new fever (patient was afebrile for >48 hours prior to this scoring) and/or temperature instability
An increase in the patient’s organ dysfunction score
Parent or nurse concern over the patient’s clinical status
Clinical signs of possible sepsis (see algorithm for details)

Who responds to a sepsis alert? PICU APP, rapid response nurse, charge nurse and bedside nurse, +/- RT, +/- lab tech and IV team

How do changes to the nurse-driven sepsis algorithm impact you as a physician or APP?

Evaluation by the sepsis team does not imply need for intervention.
If there is a need for new antibiotics, fluid bolus and/or cultures and/or transfer to the PICU, the attending physician will be notified.
Nurses will call sepsis alert independent of MD or APP presence at the bedside.

For any questions about the new sepsis screening algorithm, please contact Javier Gelvez, M.D., PICU Intensivist.