Stopping Sepsis in Its Tracks: Code Sepsis in Procedural Areas

Each year, at least 1.7 million adults in America develop sepsis, according to the Centers for Disease Control and Prevention. In addition, one in three patients who dies in a hospital has sepsis.

Hospitals throughout the Cleveland Clinic Health System (CCHS) activate a Code Sepsis to facilitate early recognition and treatment of the condition, which occurs when an infection triggers a chain reaction throughout the body that can lead to tissue damage, organ failure and death. When Toni Zito, MSN, RN, CPAN, FASPAN, heard a shared governance presentation about Code Sepsis on inpatient units at Cleveland Clinic Hillcrest Hospital, she wondered if it could be implemented in procedural units, too.

“Because the procedural areas are a mix of inpatient and outpatient, we weren’t the focus of the initial implementation of Code Sepsis,” says Zito, Perioperative Educator. “But when we heard about the protocol and how well it was working, we recognized the benefit for our patients.”

In June 2020, Zito and Angela Sotka, BSN, RN, CPAN, Nurse Manager of Perioperative Services, met with the Sepsis Steering Committee, which approved the request to develop sepsis workflows. Five months later, Hillcrest became the first Cleveland Clinic hospital to adopt Code Sepsis in procedural areas.

Team effort to create workflow

Before implementing Code Sepsis, the anesthesia team in procedural areas managed patients with sepsis.

“We treated sepsis, but we realized that Code Sepsis was a great resource that would allow us to provide the best care available,” says Zito. She and Sotka collaborated with perioperative nurses to develop a sepsis procedural area workflow and sepsis alert checklist.

“Perioperative nurses are right at the bedside and often see the early signs of sepsis in patients,” says Sotka. “Because they know what patients look like in this setting, they were instrumental in putting together procedures.” For instance, indications such as an elevated heart rate and a low temperature may trigger an alert on inpatient units, but these could be routine during post-operative care or emergence from anesthesia.

“We didn’t want all of the same alerts firing here in procedural areas because they may mean something very different,” says Sotka. “We really rely on our clinical nurses. They get reports on the patient, assign them a risk for sepsis and then act on it, if necessary.”

The process begins when a caregiver recognizes a change in the patient’s condition, such as a heart rate above 90, respiratory rate above 20, white blood cell count above 12 or below 4, and a temperature above 101.6 F or below 96.8 F. If clinical nurses confirm or suspect sepsis, they call a Code Sepsis and notify the provider.

The Code Sepsis team includes a rapid response nurse, a house officer, a phlebotomist and a nursing operations manager. The team collaborates with a member from anesthesia and uses a sepsis order set and care path to assess and care for the patient, who is transferred to the ICU or medical/surgical unit for further treatment, if necessary.

Great patient outcomes

Zito and a clinical nurse earning her MSN in nursing education developed tools to educate all staff members in procedural areas about Code Sepsis. They also rounded with every staff member. In addition, Laura Lance, MSN, RN, Sepsis Coordinator, reviews each sepsis case with caregivers in procedural areas and reeducates them.

“It’s very impactful to have these case study reviews presented at staff meetings, especially the success stories,” says Sotka. And there are many successes to share.

“There were 16 total Code Sepsis calls in 2021 in procedural areas, and all 16 were discharged from the hospital with no mortalities – amazing!” says Lance. One memorable case involved a patient who was febrile, tachycardic and hypotensive following a urology procedure.

“We called Code Sepsis, got the patient to the ICU and kept an eye on her,” says Lance. “She made a wonderful recovery.”

The workflow process also benefits clinical nurses in the procedural areas.

“Sepsis can happen really fast. When nurses call Code Sepsis, there is cavalry walking in within minutes to help them take care of this patient who is deteriorating,” says Sotka. “It’s great to have those extra hands, and it provides caregivers a sense of confidence that we can get the patient where they need to go.”

Adds Lance, “This process is so simple. It saves lives.”