Code Sepsis: Improving Sepsis Care; Saving Patients’ Lives
James R. Beardsley, Pharm.D., BCPS, Catherine M. Jones, M.D., Jason Chou, Pharm.D., M.S., Margaret Currie-Coyoy, M.B.A., Teresa Jackson, R.N., Adam Orsborn, Pharm.D., M.S.
Wake Forest Baptist Health, Winston-Salem, North Carolina
Numerous studies have demonstrated that the speed of initiating appropriate therapy positively impacts the outcomes of patients with severe sepsis and septic shock. Current guidelines recommend that adequate antimicrobial therapy be initiated within one hour of the onset of these serious conditions. After data released by the University HealthSystem Consortium (UHC) revealed that our institution’s sepsis-related mortality index was twice that of top performing UHC hospitals, our institution implemented a multidisciplinary effort to improve the care provided to our patients with sepsis.
Drawing from the concept of a “code” which is called in response to a cardiopulmonary arrest or stroke, we developed a standardized process for early identification, communication, and intervention for patients with sepsis called “Code Sepsis”. As part of this process, unstable patients were systematically screened for sepsis. If a screen indicated possible sepsis, Code Sepsis was initiated. A text page from the hospital’s emergency response system to the Inpatient Pharmacy, Respiratory Therapy, Blood Gas Laboratory, and the ICU Triage Nurse alerted these areas to be ready for new orders for the patient. Key pharmacy components in the development of Code Sepsis were to 1) enhance turnaround time by designing a systematic way to elevate Code Sepsis antibiotic orders to the highest priority, 2) task pharmacists with the responsibility of calling the nursing unit 15 minutes after Code Sepsis initiation to inquire whether or not new antibiotics were going to be needed, 3) implement a protocol that allows pharmacists to choose Code Sepsis antibiotics if the provider is tied up with other aspects of the patient’s care, and 4) work with nursing to provide tools to facilitate timely antibiotic administration.
Code Sepsis was associated with a dramatic increase in the promptness of sepsis care. The mean time from a positive sepsis screen to antibiotic administration decreased from 427 minutes to 31 minutes in the ICUs. For patients in non-critical care units the mean time from Rapid Response Nurse arrival until antibiotic administration decreased from 396 minutes to 51 minutes. Mortality index dropped from 1.65 for the five quarters prior to Code Sepsis implementation to 0.8 for April 2013 – March 2014. This equates to over 200 lives saved per year. Our hospital is now considered one of the top 10 performing UHC institutions for this metric.
Code Sepsis is a unique, multidisciplinary approach to sepsis care that has been very successful for our institution. These efforts have produced a dramatic improvement in process metrics related to order turnaround time and antibiotic administration and a remarkable reduction in sepsis-related mortality.