By investing a few minutes, home care clinicians can make a world of difference
by Chris Chimenti, MSPT, ACCH, Senior Director of Clinical Innovation, HCR Home Care
What is sepsis? According to the Centers for Disease Control and Prevention (CDC), “Sepsis is the body’s extreme response to an infection. It is a life-threatening medical emergency! It happens when an infection you already have – in your skin, lungs, urinary tract, or somewhere else – triggers a chain reaction throughout your body. Without timely treatment, sepsis can rapidly lead to tissue damage, organ failure, and death”.1
The figures are staggering:
- Over 1.6 million people are diagnosed with sepsis each year in the U.S.2
- The risk of death from sepsis increases by 8% every hour treatment is delayed.2
- The onset of sepsis occurs outside of a hospital setting in nearly 80 percent of cases.3
Nurses and therapists working in the home health care setting are uniquely positioned to detect sepsis, and detect it sooner than later with routine screening. Time is of the essence when sepsis begins… it’s an emergent event. Clinicians should educate patients who have an infection or are at risk of infection about the warning signs of sepsis. Family members and anyone involved in the care of the patient should be informed as well.
Who is at risk?
- Children < 1 year old
- Adults 65 and older
- Individuals with an impaired immune system
- Patients with chronic illnesses such as diabetes or cancer
What are the warning signs?
- Confusion or disorientation
- Rapid heart rate
- Shortness of breath
- Hyperthermia or hypothermia
- Shivering
- Sweaty or clammy skin
- Extreme pain
At HCR Home Care, sepsis screening is an integral part of our daily patient assessments. The Home Care Association (HCA) Sepsis Screening Tool4 is embedded in our electronic medical record (EMR) system. This standardized instrument streamlines the clinical assessment to promptly identify the critical signs and symptoms of sepsis. Upon completion of the three screening questions, the EMR automatically generates follow-up actions that align with established medical standards.
What are the three items included in the screening tool?
- Active infection or potential source of infection
- Fever, tachypnea, or tachycardia
- Organ dysfunction (e.g., altered mental status, hypotension)
Our nurses and therapists have conducted the standardized sepsis screens during every home visit over the past 12 months. During this time, over 175,000 individual screens have been performed. 141 patients presented with symptoms consistent with severe sepsis and required immediate transport to a local hospital emergency room. During the same time period, another 125 patients met criteria for sepsis and physician notification immediately followed.
At times, sepsis may not be included as a diagnosis in hospital discharge instructions. This may be due to the fact the symptoms associated with sepsis resolved during the hospital stay. According to the Sepsis Alliance, 62 percent of patients who develop sepsis are likely to be re-hospitalized in the subsequent 30 days.2 Eliminating potentially avoidable hospitalizations is a critical focus in home health practice today. Awareness of sepsis can make a difference in keeping patients at home and out of the hospital.
Sepsis deserves to be understood, appreciated, and closely monitored. The condition can result from a simple scrape, urinary tract infection, or surgery. Early detection and prompt medical attention are needed to prevent the worst…amputation, organ failure, or death. Be prepared to ask yourself…“could this be sepsis?” You could just make a world of difference for your patient.
References:
1 What is Sepsis? Accessed on 9/6/18.
2 Sepsis Fact Sheet. Accessed on 9/6/18.
3 CDC: Most Sepsis Cases Start Outside A Hospital. Accessed on 9/5/18.
4 Stop Sepsis At Home. Accessed on 9/7/18.
Additional Resources:
Signs of Infection and Sepsis at Home (Great Plains QIN)
Sepsis Information Guides (Sepsis Alliance)
Stop Sepsis Tools & Resources (Home Care Association of New York – HCA)
Sepsis – It’s About TIME Infographic (sepsis.org)
HHQI National Campaign 