After a three-year campaign by residents, including sepsis survivor Nicole Taylor and her family, and the Rory Staunton Foundation, New Jersey Mandatory Sepsis Protocols Should Make Their Way to ALL New Jersey hospitals!
But we’re not there yet…
Public comment on the proposed rule change has closed and thank you all for referencing our advice!
“I want mandatory, life-saving sepsis protocols in New Jersey hospitals!” “Proposed New Rule: N.J.A.C. 8:43G-14.9/Hospital Licensing Standards – Infection Control: Sepsis Protocols”
…Yes, there are hospitals in NJ that have sepsis protocols in place, but not every hospital. …what if you or your loved ones go to a hospital that doesn’t follow sepsis protocols?
We can NOT allow “choosing the right hospital” to determine life or death with regards to sepsis!
We appreciate the work of Commissioner Bennett and hope that you encourage her to implement these protocols immediately to start saving lives. ALL New Jersey residents deserve life-saving sepsis protocols in ALL hospitals – NOW!
Join us in making New Jersey SAFE FROM SEPSIS!
By Kathleen J. Davis
Published by WESA Pittsburg’s NPR News Station, September 8, 2017
Sepsis is the leading cause of hospital deaths in the country, killing 250,000 Americans each year. The bacterial infection, colloquially known as “blood poisoning,” can be caused by contamination in a hospital setting, and in deadly situations results in organ failure.
A research team at the University of Pittsburgh has received a grant from the Department of Health and Human Services to study sepsis in hospitals for the next four years. The team will look at data from New York hospitals to figure out what kinds of state policies work when it comes to preventing and treating sepsis. That means strategies like administering early antibiotics and controlling the source of infection in the hospital.
Jeremy Kahn, part of the research team, says mistakes can happen when treating sepsis in hospitals.
“When that happens, there’s a role for health policy makers to step in and create health policies that incentivize physicians to do a better job,” he said.
Many states, including Pennsylvania, have no sepsis-related rules on the books, meaning strategies for combating the infection can vary from hospital to hospital. New York implemented “Rory’s Regulations” across the state in 2013, requiring all hospitals to follow a set of proven protocols in a case of sepsis. The law was named after a 12-year-old boy who died of the infection in a New York hospital after scraping his arm at school.
Rory’s Regulations also require hospitals to disclose all sepsis-related data to the state, which is why the research team is looking at their data to figure out what kinds of state policies work when it comes to preventing and treating sepsis.
Kahn says policy makers in Harrisburg have been developing a sepsis policy for about a year, which will ultimately require all Pennsylvania hospitals to adopt protocols for sepsis recognition and sepsis treatment.
Rory is making history again – New York Schools will teach back-to-basics education for treating wounds, will educate regarding infection and teach lifesaving lessons about sepsis.
Read the New York State Education Department press release here.
The Center For Disease Control has just released a video on sepsis as part of a nationwide sepsis awareness campaign. The video outlines the domino effect of sepsis and the importance of speedy medical intervention.
August 1, 2017, the Rory Staunton Foundation and the Patient Safety Movement Foundation joined forces in Vermont to discuss the implementation of mandatory sepsis protocols.
Rory Staunton Foundation Co-Founder, Ciaran Staunton, and Regional Chairs/Volunteers Mari Miceli and Georgi D’Alessandro of the Patient Safety Movement Foundation met with Vermont Commissioner of Health, Dr. Mark Levine, and the Vermont State Epidemiologist for Infectious Disease, Dr. Patsy Tassler Kelso, to urge the implementation of Rory’s Regulations in all Vermont hospitals.
In May 2017, the New England Journal of Medicine (NEJM) confirmed that Rory’s Regulations in New York State hospitals are saving lives. We thank the Commissioner and Dr. Patsy Tassler Kelso for their attention to this urgent health issue and look forward to helping Vermont become the next “sepsis safe” state.
By Konrad Reinhart, M.D., Ron Daniels, M.D., Niranjan Kissoon, M.D., Flavia R. Machado, M.D., Ph.D., Raymond D. Schachter, L.L.B., and Simon Finfer, M.D.
Published by New England Journal of Medicine, August 03, 2017 |
“Some very important clinical issues, some of them affecting life and death, stay largely in a backwater which is inhabited by academics and professionals and enthusiasts, dealt with very well at the clinical and scientific level but not visible to the public, political leaders, leaders of healthcare systems. . . . The public and political space is the space in which [sepsis] needs to be in order for things to change.”
So said Sir Liam Donaldson, the former chief medical officer for England and the current World Health Organization (WHO) envoy for patient safety, on May 24, 2017.1 Two days later, the World Health Assembly (WHA), the WHO’s decision-making body, adopted a resolution on improving the prevention, diagnosis, and management of sepsis.2
The term “sepsis” dates back to at least the time of Hippocrates, who considered it the process by which flesh rots and wounds fester. More recently, it has been defined as life-threatening organ dysfunction resulting from infection. Despite this long history, sepsis has existed in the backwater described by Donaldson, and as a result innumerable patients around the world have died prematurely or faced long-term disability. This toll of unnecessary suffering drove Germany, with the unanimous support of the WHO executive board and at the urging of the Global Sepsis Alliance (GSA), to propose the resolution adopted by the WHA. The resolution urges member states and the WHO director general to take specific actions to reduce the burden of sepsis through improved prevention, diagnosis, and management (see table.
The true burden of disease arising from sepsis remains unknown. The current estimates of 30 million episodes and 6 million deaths per year come from a systematic review that extrapolated from published national or local population estimates to the global population.3 The likelihood that the result was a significant underestimate was recognized by the authors, who could find no data from the low- and middle-income countries (LMICs) where 87% of the world’s population lives. Thus, their estimate is based on data on hospital-treated sepsis in high-income countries. This lack of data is compounded by the fact that sepsis is treated as a “garbage code” in the Global Burden of Disease statistics, where most deaths due to sepsis are classified as being caused by the underlying infection. Improving the coding of sepsis and establishing a proper accounting in those statistics are essential steps envisaged by the WHA.
The resolution also calls for health care workers to increase awareness of sepsis by using the term “sepsis” in communication with patients, relatives, and other parties.4 National surveys consistently report low community awareness of sepsis, its signs and symptoms, its causes, and its toll of death and disability. In Australia, only 40% of surveyed people had heard of sepsis and only 14% could name one of its signs. In Brazil, the figures are even lower, with 7% of surveyed people aware in 2014 and 14% in 2017. In the United States, the United Kingdom, and Germany, high-profile campaigns have proven effective and increased awareness to 55%, 62%, and 69%, respectively.
Ensuring greater awareness on the part of both the public and health care workers is a crucial step in reducing the global burden of sepsis. Approximately 70% of sepsis cases are community-acquired, and since treatment with appropriate antibiotics must begin early to be effective, educating people about seeking treatment without delay is key to preventing unnecessary deaths and disability. The progression from infection to sepsis can be insidious and is unpredictable. Although populations such as the very young, the very old, and the immunosuppressed are known to be at high risk and should be targeted for education, sepsis can affect anyone at any time, which means that national public awareness programs are needed.
Awareness programs should also teach health care workers both to recognize sepsis and to understand it as a true time-critical medical emergency. Government reports and individual patient stories consistently identify delayed treatment as a major cause of preventable death and disability.5 Encouraging patients, relatives, and health care workers to ask “Could this be sepsis?” saves lives.
Clear treatment guidelines and performance targets tailored to local environments and available resources are also essential. Effective examples of this approach that have reduced mortality can serve as templates to be adapted for local conditions and use; these include “Rory’s Regulations” in New York State, the “Sepsis Kills” program in New South Wales, Australia, the National Health Services’ commissioning levers in England, and a multifaceted education program in Brazil.
Promulgation of comprehensive treatment guidelines such as those developed by the Surviving Sepsis Campaign has been associated with reduced mortality in high-income countries, but guidelines written for and by clinicians in these countries may not be applicable in the LMICs that bear most of the sepsis burden. Context-specific guidelines or modification of current guidelines for individual LMICs will be most effective if the guideline process is led by local clinicians and policymakers; the resolution envisages the WHO, in collaboration with others, playing a role in the development and promulgation of such guidelines. In addition, attention to bolstering public health initiatives to prevent sepsis, surveillance systems for detecting outbreaks early, and provision of simple early treatment can help to counterbalance the effects of a lack of critical care facilities in many LMICs.
The WHO resolution recognizes the perceived conflict between rapid administration of antibiotics to treat sepsis and efforts to combat antimicrobial resistance. Global efforts to reduce the burden of sepsis must go hand in hand with measures to minimize antimicrobial resistance and be consistent with the WHO-approved Global Action Plan on Antimicrobial Resistance. However, sepsis is the condition that is most appropriate to treat empirically with broad-spectrum antibiotics, with rapid deescalation based on identification of the causative organisms.
Progress toward the GSA’s vision of “a world free of sepsis” also requires recognition of the key role of prevention. Prevention of infection and resultant sepsis through vaccination; access to clean water, sanitation, and hygiene (WASH) in homes, schools, and health care facilities; clean childbirth and surgical practices; and hand hygiene in health care facilities is already the focus of WHO programs. The new resolution on sepsis supports and reinforces these programs.
Increased awareness, early presentation to a health care facility or early recognition of health care–associated sepsis, rapid administration of appropriate antibiotics, and urgent treatment according to locally developed guidelines can significantly reduce deaths from sepsis. Since such measures have reduced case fatality rates in high-income countries, however, the substantial burden carried by survivors of sepsis has become clearer. The sequelae of sepsis can include clinically significant physical, cognitive, and psychological disability that often goes unrecognized and untreated. In LMICs, postdischarge mortality after sepsis is about the same as sepsis-related mortality in the hospital, and perinatal sepsis poses great and ongoing risks for both mother and infant. Yet around the world, coordinated services for sepsis survivors are virtually nonexistent.
The WHA resolution, with its implicit recognition of sepsis as a major threat to patient safety and global health, has the potential to save millions of lives. To realize this potential, the actions proposed in the resolution need to be taken. These actions require coordinated efforts by politicians, policymakers, health care administrators, researchers, and clinicians working with people of all ages in all health care settings and in the community. Actions will vary by region and country and must acknowledge the unique challenges faced by LMICs.
To read the original article on NEJM.org, please click here.
Disclosure forms provided by the authors are available at NEJM.org.
This article was published on June 28, 2017, at NEJM.org.
From Jena University Hospital, Jena, Germany (K.R.); the Heart of England NHS Foundation Trust, Birmingham, United Kingdom (R.D.); the Department of Pediatrics, Emergency Medicine and Critical Care, University of British Columbia (N.K.), and Synergy Business Lawyers (R.D.S.) — both in Vancouver, Canada; the Department of Anesthesiology, Pain and Intensive Care Medicine, Federal University of São Paulo, São Paulo (F.R.M.); and the George Institute for Global Health, University of New South Wales, Sydney (S.F.). The authors constitute the Executive Board of the Global Sepsis Alliance.
By John Tozzi
Published by Bloomberg, July 14, 2017, 4:00 AM EDT |
Sepsis—a frequently lethal condition in which the body’s immune system attacks its own organs while trying to fight off infection—is the top killer in U.S. hospitals, and the country has only recently begun to understand the scope of the problem.
A new government report suggests that sepsis cases tripled in the decade from 2005 to 2014, causing 1.5 million hospital stays by the end of that period. That’s alarming, but it may be misleading, too. Experts who study sepsis say the apparent increase is actually a reflection of how doctors are getting better at identifying cases they used to miss.
The medical world “is actually recognizing a much more common condition than we realized in the past was actually there,” says Greg Martin, a critical-care doctor and professor at Emory University School of Medicine who studies sepsis.
Sepsis is a fast-moving illness that occurs when the body’s own attempt to defeat an outside infection damages tissues and organs. There’s no single test to diagnose it—doctors must piece together a combination of symptoms and biological signals. It can make the heart race, cause trouble breathing, give patients fever or chills, and cause extreme pain. It’s more likely to occur in older people and those with other illnesses. It may play a role in up to half of all hospital deaths.
Saving patients from sepsis, sometimes called septicemia or septic shock, depends on quickly getting them antibiotics, fluids, and other measures to stabilize them. New York State recently issued rules requiring hospitals to follow treatment guidelines after the high profile sepsis death of a 12-year-old boy whose diagnosis doctors initially missed. Other states may follow.
The recent attention is understandable. A federal tally of hospital billing data shows a dramatic and steady rise in sepsis cases. A new brief from the Agency for Healthcare Research and Quality, a federal agency that studies clinical practices, found that sepsis was the most common reason for hospital stays, with the exception of pregnancy and childbirth. Treating it cost $27 billion in 2014, or about $18,000 per case.
But relying on hospital discharge data, which describe how hospitals bill for patient visits, may elide the true trends in disease rates. “Coding doesn’t always match what’s really happening,” Martin, the Emory University professor, says.
Research presented at a conference in May and funded by the Centers for Disease Control used clinical data from digital health records at 412 hospitals to estimate how common sepsis is nationally. That analysis came up with a similar number to the new federal report: About 1.67 million cases in 2014. It also found that the number has been stable since 2009. In other words, the same number of sepsis cases may have been there all along.
The difference now seems to be that doctors are getting better at spotting it, hence the upward tick in hospital coding.
“There’s a large focus on increasing awareness of sepsis,” says Chris Seymour, an assistant professor of critical care and emergency medicine at University of Pittsburgh School of Medicine. “The hope is that by alerting the public as well as general practitioners and other people who treat simple infections, that we can educate them about the signs and symptoms,” he says.
Sepsis payments can be more than three times the fees for pneumonia, an infection that frequently precedes sepsis.
Hospitals also have incentives to record sepsis cases that may have previously been attributed to other diagnoses. Doing so can make them look better on federal measures of hospital quality and increase reimbursements, Emory’s Martin says. Sepsis payments can be more than three times the fees for pneumonia, an infection that frequently precedes sepsis, he says.
The same federal data that shows sepsis cases tripling in a decade also shows hospital stays for pneumonia dropping by one-third in the same period. If doctors are getting better at identifying sepsis, and hospitals have an incentive to bill for it, that could explain why a patient who got a diagnosis of pneumonia in 2005 might be considered a case of sepsis ten years later.
Still, the steady upward march of hospital visits attributed to sepsis suggests there is some true increase underlying the numbers, says Anne Elixhauser, a senior research scientist with the Agency for Healthcare Quality and Research, who co-authored the report. When a change is simply related to coding or reimbursement, the increase is typically a more sudden, single-year jump, not a decades-long trend.
True sepsis rates are rising partly because the population is aging, says Steven Simpson, director of pulmonary and critical care at University of Kansas Medical Center. Medicine is also getting better at keeping alive people with serious illnesses, such as organ recipients, cancer patients, and those with autoimmune conditions like HIV—all more susceptible to sepsis. And people without health insurance or access to care may delay treatment for a lesser infection until it becomes more severe.
“Sepsis has been growing, growing, growing for a long time,” Simspon says.
The increasing problem of antibiotic resistant superbugs that render medicines impotent may also play a small role in rising sepsis cases, he says, but it’s not driving the trend. As resistant organisms become more common, however, the danger is likely to increase. “If you have an infection and you are treated with an ineffective antibiotic, you are more likely to develop sepsis,” Simpson says. “Sepsis is what we save our antibiotics for.”
Read the original article on Bloomberg here.
Rory Staunton Foundation welcomes New Jersey State Health Commissioner’s announcement on the implementation of mandatory sepsis protocols!
Following a number of meetings with Commissioner Bennett and her staff over the past few years we welcome the Commissioner’s statement “while sepsis protocols have been an increasing focus of New Jersey hospitals, we know early identification and prompt treatment of sepsis is critical to survival. Every minute counts.” Today we thank the Commissioner for her action on changing regulations so that sepsis protocols will become mandatory in New Jersey.
Last December one of our delegations included New Jersey resident and sepsis survivor and National Family Council member Nicole Taylor who told her story of near death from sepsis, Nicole along with her family and others have been working furiously to secure mandatory protocols in the State.
The regulations are open to public comment from now until August 18th.
Read the NJ Spotlight article here
By Jayne O’Donnell
Published by USA Today, May 22, 2017
New York regulations named after a 12-year-old victim of sepsis increased the chance of survival from the potentially deadly condition, a study out Sunday shows.
“Rory’s Regulations,” named for the late Rory Staunton of New York City, requires hospitals to quickly perform a checklist of safety measures when people show up at hospitals with sepsis. A report in the New England Journal of Medicine Sunday found the faster hospitals completed the checklist of care and administered antibiotics, the lower the risk of death in hospitals from sepsis. With each additional hour it took, the risk of death increased 4%.
Sepsis, which occurs when the body’s response to an infection injures its own tissues and organs, is the biggest killer of hospital patients. More than 1.5 million cases of sepsis occur in the U.S. annually and more than 20% of people who contract sepsis die from it.
Rory Staunton died five days after falling and getting a cut on his arm in his school gym.
“This is an amazing policy that happened,” says University of Pittsburgh medical school assistant professor and physician Chris Seymour, lead author on the study.
“Minutes matter, and it is critical to perform the correct tests and get the patient antibiotics as fast as possible,” said co-author Mitchell Levy, a physician and professor at Brown University’s medical school.
Ciaran Staunton, Rory’s father, says he seldom uses this word but calls the findings “huge.”
“I have met a lot of the families saved in New York because they had to rule out sepsis,” says Staunton. “I’ve been to the grave sites in other states where there were no protocols.”
Read the original story on USA Today here.
By Lauran Neergaard
WASHINGTON — Minutes matter when it comes to treating sepsis, the killer condition that most Americans probably have never heard of, and new research shows it’s time they learn. Sepsis is the body’s out-of-control reaction to an infection. By the time patients realize they’re in trouble, their organs could be shutting down. New York became the first state to require that hospitals follow aggressive steps when they suspect sepsis is brewing. Researchers examined patients treated there in the past two years and reported Sunday that faster care really is better.Every additional hour it takes to give antibiotics and perform other key steps increases the odds of death by 4 percent, according to the study reported at an American Thoracic Society meeting and in the New England Journal of Medicine.That’s not just news for doctors or for other states considering similar rules. Patients also have to reach the hospital in time.
Published by Washington Post, May 21, 2017
“Know when to ask for help,” said Dr. Christopher Seymour, a critical care specialist at the University of Pittsburgh School of Medicine who led the study. “If they’re not aware of sepsis or know they need help, we can’t save lives.”
The U.S. Centers for Disease Control and Prevention last year began a major campaign to teach people that while sepsis starts with vague symptoms, it’s a medical emergency.
To make sure the doctor doesn’t overlook the possibility, “Ask, ‘Could this be sepsis?’” advised the CDC’s Dr. Lauren Epstein.
SEPSIS IS MORE THAN AN INFECTION
Once misleadingly called blood poisoning or a bloodstream infection, sepsis occurs when the body goes into overdrive while fighting an infection, injuring its own tissue. The cascade of inflammation and other damage can lead to shock, amputations, organ failure or death.
It strikes more than 1.5 million people in the United States a year and kills more than 250,000.
Even a minor infection can be the trigger. A recent CDC study found nearly 80 percent of sepsis cases began outside of the hospital, not in patients already hospitalized because they were super-sick or recovering from surgery.
THERE’S NO SINGLE SYMPTOM
In addition to symptoms of infection, worrisome signs can include shivering, a fever or feeling very cold; clammy or sweaty skin; confusion or disorientation; a rapid heartbeat or pulse; confusion or disorientation; shortness of breath; or simply extreme pain or discomfort.
If you think you have an infection that’s getting worse, seek care immediately, Epstein said.
WHAT’S THE RECOMMENDED CARE?
Doctors have long known that rapidly treating sepsis is important. But there’s been debate over how fast. New York mandated in 2013 that hospitals follow “protocols,” or checklists, of certain steps within three hours, including performing a blood test for infection, checking blood levels of a sepsis marker called lactate, and beginning antibiotics.
Do the steps make a difference? Seymour’s team examined records of nearly 50,000 patients treated at New York hospitals over two years. About 8 in 10 hospitals met the three-hour deadline; some got them done in about an hour. Having those three main steps performed faster was better — a finding that families could use in asking what care a loved one is receiving for suspected sepsis.
WHO’S AT RISK?
Sepsis is most common among people 65 and older, babies, and people with chronic health problems.
But even healthy people can get sepsis, even from minor infections. New York’s rules, known as “Rory’s Regulations,” were enacted after the death of a healthy 12-year-old, Rory Staunton, whose sepsis stemmed from an infected scrape and was initially dismissed by one hospital as a virus.
Illinois last year enacted a similar sepsis mandate. Hospitals in other states, including Ohio and Wisconsin, have formed sepsis care collaborations. Nationally, hospitals are supposed to report to Medicare certain sepsis care steps. In New York, Rory’s parents set up a foundation to push for standard sepsis care in all states.
“Every family or loved one who goes into a hospital, no matter what state, needs to know it’s not the luck of the draw” whether they’ll receive evidence-based care, said Rory’s father, Ciaran Staunton.
Copyright 2017 The Associated Press. All rights reserved.
Read the original article on The Washington Post here.