TOPIC

DISCUSSION

Sepsis Protocol

Dr. Erfan Hussain

The impetus for the development of new protocols for Sepsis is that we did not perform as well as we should have in the Premier and Healthgrades results.  Some of that is a lack of proper coding of patients with sepsis, severe sepsis and septic shock.  If you have a patient with sepsis, severe sepsis or septic shock, please include that in the differential of problems that you are writing on the patient.  It will help the coders and help us get a better denominator.  New sepsis procedure forms are available on forms on demand.  When you have identified a patient with any form of sepsis, we ask that you print the forms and begin the algorithm, which covers how to proceed with the septic patient.  If the guidelines outlined do not work you will need to activate the Rapid Response Team.  They will come and take the resuscitation of the patient to the next level, which involves the insertion of a CVP and then resuscitation against prescribed CVP goals and then eventually against venous saturation.  A determination is then made on whether to leave the patient where they are or move them to an ICU.

Sepsis is the number one killer in non-coronary ICU’s.  Incidence wise, it is higher than CHF, breast and colon cancer and its mortality is just a bit less than that of acute MI. 

IT Update

Dr. Mike Oppenheim

We have gotten good feedback on ways we can make information easier to enter and retrieve and will shortly be releasing some enhancements, including being able to multi-select multiple dx’s.  We are working with PST’s to link the PST’s and H&P on the document tab so that everything is there on the day of surgery.  Until that happens, you need to sign in signature manager with one click and then sign a paper attestation on the day of surgery which states that nothing has changed since PST’s. 

We will put up signs in the Medical Staff office indicating the Help Desk number, along with the option # for password reset and Sunrise help.  We will also try and have the number posted on the Sunrise screen. 

There will be a CPOE preview on July 30^th at LIJ.  If you are interested, let Mike Oppenheim know.  We will be holding CPOE preview sessions here at NS when we get closer to implementation

Hotline Calls

Andrea Restifo

1. ISSUE: physician was told unit secretary forgot to re-enter order for daily PT’s after 3^rd day, as there is a 3 day max on entering orders in computer; physician stated daily lab orders that are essential such as PT, should not be "cancellable"

RESOLUTION: if there is a re-occurring order (more than 3 days) and the value "999" is entered in the "duration" field, the system will automatically build the additional occurrence each day until someone cancels the order in the system. Staff does not need to re-order the tests every 3 days if they follow the steps outlined above.  Renee notified the nursing units of this feature -

2. ISSUE: phone numbers such as the physician hot line and the help desk are very difficult to get and should be permanently posted throughout the hospital

RESOLUTION: PUT UP POSTER in MD lounge

3 ISSUE: The hospital needs a better procedure for non-formulary medications - a printed notification is sent back to the patient care floor for follow-up.  Physician wrote admission orders on 5/25; his patient did not receive his 5/26 9AM non-formulary medication until 10 PM; on 5/27 he was told that 3 other medications ordered at the time of admission were also non-formulary and the patient had not yet received them.

RESOLUTION: Len Langino spoke w/ physician –

4. ISSUE: surgeon had 5 cases scheduled in a "fast track" room and was delayed because of PACU delays.  He said in 10 hours he had done 3 cases - OR time for these cases was 6 1/2 hrs and the delays totaled 3 1/2 hrs.  He said turn over time was not an issue, the delays were due to PACU delays

RESOLUTION: Pat Moleski confirmed she will address at June MSA