Early Identification of Sepsis

Sometimes when bad things happen, it can lead to changes to help prevent poor outcomes in the future.   This is true for sepsis care in New York State.  NYS is the first state to apply mandated laws for hospitals to set in place protocols for sepsis care. The NYS push comes from a 12 year old boy who died as a result of early warning signs of sepsis being missed. Click here to read more about Rory and how his parents have been advocates to prevent this from happening again.

As part of the NYS regulations hospitals must have protocols in place to help identify early warning signs of sepsis- (8) hospitals shall have in place evidence-based protocols for the early recognition and treatment of patients with severe sepsis and septic shock that are based on generally accepted standards of care as required by subdivision (a) of section 405.4 of this Part. Patients who are identified and treated earlier have improved survival outcomes from sepsis (Tazbit, 2012).

 One way to complete this is to use a tool called Modified Early Warning System or MEWS for short.  MEWS is a tool which assists healthcare personnel to identify the early signs of sepsis. MEWS takes key vital signs/assessments and alerts practitioners when the there is a change in vital signs. Changes in vital signs may be subtle; therefore practitioners are less likely to pick up the slight changes.

Here is what a MEWS adult score card can look like:

Pediatric monitoring can be more difficult to the varying vital signs for every age group.  Here is a sample for the pediatric monitoring tool.

 

Facilities who are using electronic health records (EHR) can integrate the monitoring tools into the EHR to continuously monitor patients for changes. The healthcare system that I currently work for has built this into our EHR and practitioners are given a best practice alert for changes in the MEWS. The nursing staff is alerted when there is a change in the MEWS score with a protocol for the response.

Whether using the adult or pediatric monitoring tool it is always important to remember the early warning systems are tools to help us care for the patients, but we must always use critical thinking and good assessment skills. Nurses should notify the physician with changes in patients or a gut feeling something is not right. Tools cannot always pick up subtle changes that the human-human interface can.



 

Tazbir, J. (2012). Early Recognition and Treatment of Sepsis in the Medical-Surgical Setting... [published erratum appears in MEDSURG NURS; 2012 Sep-Oct; 21(5): 270]. MEDSURG Nursing, 21(4), 205-209.