Life After Sepsis: Post-Sepsis Syndrome. Sepsis Virtual Event July 6, :00 1:00 p.m. CT

Transcription

1 Life After Sepsis: Post-Sepsis Syndrome Sepsis Virtual Event July 6, :00 1:00 p.m. CT 1

2 Mallory Bender, LCSW Program Manager, HRET WELCOME AND INTRODUCTIONS 2

3 Summary Disclosure & Accreditation Statement AHA/HRET Hospital Improvement Innovation Network (HIIN) Life after Sepsis: Post Sepsis Syndrome Online Live Webinar July 6, 2017 The planners and faculty of the HRET HIIN Life after Sepsis: Post Sepsis Syndrome webinar have indicated no relevant financial relationships to disclose in regard to the content of this presentation. This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical education through the joint providership of the American Board of Quality Assurance and Utilization Review Physicians, Inc. (ABQAURP) and Health Research & Education Trust (HRET). ABQAURP is accredited by the ACCME to provide continuing medical education for physicians. The American Board of Quality Assurance and Utilization Review Physicians, Inc. designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credits. Physicians should only claim credit commensurate with the extent of their participation in the activity. ABQAURP is an approved to provide continuing education for nurses. This activity is designated for 1.0 Nursing Contact Hours through the Florida Board of Nursing, Provider #

4 Today s Agenda 4

5 WEBINAR PLATFORM QUICK REFERENCE Mute computer audio Today s presentation Chat with participants Download slides/resources Register for upcoming events

6 How Did You Hear About Today s Virtual Event? A) HRET HIIN flyer B) HRET HIIN website C) HRET LISTSERV D) State hospital association E) QIN-QIO F) Your organization/colleague G) Other, please specify.

7 7

8 Data Updates 8

9 Post-Sepsis Care Syndrome- Surviving Sepsis is Just the Beginning Elizabeth Scruth PhD MPH RN CCNS CCRN FCCM Clinical Practice Consultant Clinical Effectiveness Team- Quality Division Kaiser Permanente NCAL 9

10 Objectives Describe the sequelae most common in sepsis survivors Identify risk factors that contribute to post sepsis care syndrome 10

11 Background Sepsis is an increasing burden in the USA Sepsis management has led to decreased mortality rates Increased number of survivors Little known about survivors of sepsis Sepsis survivors have increased healthcare utilization post survival Ongoing mortality up to 2 years post sepsis Sun, et al. Critical Care Medicine. 2016: Dick, Liu, Zwanziger et al. BMC Health Services Research

12 Sepsis survivors increased healthcare usage in the first year Increased 30 day readmission rates RBC transfusion, TPN and longer duration of antibiotics ( main risk factors) Insurance status, hospitalizations in prior year, length of stay Study showed 50% of the readmissions unresolved or recurrent infections Sun et al. Crit Care Med

13 Long term care admissions and home healthcare Two times more likely to be admitted to SNF in the five years after a sepsis admission Dick et al. BMC Health Services Research

14 Beneath Our Understanding of Sepsis 14

15 Sepsis and Chronic Health Chronic conditions increase risk of sepsis Most common infectious disease of hospitalization pneumonia leading to severe sepsis Chronic Health Conditions Diabetes Heart failure Cardiovascular disease Reduced lung function-severe Cognitive impairments Chronic kidney disease Yende, Iwashyna, Angus. Trends Mol Med

16 Severe reduction in lung function and or diabetes increases risk of pneumonia by over six fold- common cause of severe sepsis Unmeasured subclinical changes thought to play a role Circulating interleukin (IL)- 6, tumor necrosis factor ( TNF) and C-reactive protein ( CRP) Yende, Iwashyna, Angus., Trends Mol Med,

17 The Sequelae of Sepsis Severe sepsis/septic shock worsens Cognitive function Physical impairment Chronic kidney disease Cardiovascular disease Sleep patterns ( Common up to one year after sepsis) May persist for several years and accelerate underlying chronic diseases Shah et al. Am J Resp Crit Care Med.2013; Wunsch et al. JAMA. 2010: Iwashyna et al. JAMA. 2010: Altman et al. Ann Amer Thorac Soc

18 During the sepsis event the following may affect the long term recovery: Interventions- medications, early rehabilitation Immobilization Delirium Depression/anxiety Magnitude of host immune response Shah et al. Am J Resp Crit Care Med. 2013; Kellum et al. Arch Intern Med. 2007; Wunsch et al. JAMA

19 Impaired Immune Response Septic shock- tissue damage Preserving organ function during sepsis- effect on chronic health- complex Impaired immune response from sepsisdeaths up to 1 year post index event Sepsis survivors- more susceptible to infections reducing their quality of life (herpes zoster, lower airway infections) Medzhitov et al. Science. 2012; Kellum et al. Arch Intern Med. 2007; Arens et al. Critical Care

20 Social and Environmental Factors Both influence the development of severe sepsis and its outcomes Race and marital status Exposure to infection and health behaviors Health systems and family environment restoration of function family involvement/equipment needed Cox et al. Intensive Care Med

21 Preventing Sequelae from Sepsis? We know how to prevent mortality-but what about mitigating morbidity in sepsis? 21

22 Our actions/inactions/delays have long-term effects on the lives of our patients 22

23 23

24 Next Steps for Patients with Post Sepsis Syndrome Suzie Fletcher BSN, RN, CMSRN Sepsis Coordinator Wesley Healthcare 24

25 ABOUT US Wesley Healthcare Wichita, Kansas Tertiary hospital licensed for 850 beds Teaching Hospital Children s Hospital Women s Hospital Over 500 babies delivered per month Smaller 85 bed hospital (Wesley Woodlawn Hospital and ER) 3 Emergency departments Pediatric emergency department 2 free standing emergency departments 25

26 Post- Discharge Clinic Planning Need for clinic 30 for days post-discharge transitional care Health Promotion Model (Kessler, Renggli, & Swiss Centre for International Health, 2011) Almost 20 percent of all Medicare patients are readmitted within 30 days (Alper, O Malley, and Greenwald, 2017) The cost of unplanned readmissions is 15 to 20 billion dollars annually (Beresford, 2011) Reduction in readmits Reduction in mortalities 26

27 Resources for: Post- Discharge Clinic Planning o Assessment of current medical status o Medication review and education o Disease management education o Focus on social environment and other non-medical issues 27

28 Next Steps Resources Data gathering Finance Written Proposal? 28

29 Contact Information Suzie Fletcher BSN, RN, CMSRN Sepsis Coordinator Wesley Medical Center 550 N. Hillside Wichita, Kansas Phone: (316) Cell: (316) Fax: (316)

30 References Alper, E., O Malley, T.A., & Greenwald, J. (2017, April 3). Hospital discharge and readmission. Beresford, L. (2011, December). Is a post-discharge clinic in your hospital s future? The Hospitalist Retrieved from Kessler, C., Renggli, V., & Swiss Centre for International Health. (2011, March 21). Health promotion: Concepts and practices. Retrieved from motion+model&rlz=1c1ggrv_enus751us751&oq=swiss+center+for+international+hea lth+health+promotion+model&aqs=chrome..69i j0j9&sourceid=chrome&ie=ut F-8 30

31 Its Not Just About Mortality Tools for Prevention & Recognition Maryanne Whitney Steve Tremain 31

32 Our actions/inactions/delays have long-term effects on the lives of our patients 32

33 Early Recognition Back to Basics Screening all ED patients at triage Screening all seriously ill inpatient Use BPA s Create action with a (+) sepsis screen Alerts, rapid response teams 33

34 Decrease Morbidity & Mortality Treat with urgency Blood cultures and lactate Antibiotics within the golden hour Fluid 30ml/kg for patients who are hypotensive of lactate >4mmol/L Early source identification and control 34

35 35

36 Resources df 36

37 37

38 Let s hear from you! Open the Lines 38

39 Bring It Home Mallory Bender, Program Manager, HRET 39

40 Continuing Education Credits Launch the evaluation link in the bottom left hand corner of your screen If viewing as a group, each viewer will need to submit separately through the CE link 40

41 THANK YOU! 41