Dorie Murray, MSN, RN, CNL, CCRN, the Sepsis Coordinator at Medical City North Hills talks about sepsis and how her hospitals’ work with firefighters is saving lives.
Interview conducted by Ivanhoe Broadcast News in December 2017.
What is sepsis?
Dorie: Sepsis is the body’s overwhelming reaction to an infection. A lot of people believe that it’s a type of blood infection or when you hear people say that they have MRSA that is all untrue. When your body comes down with any type of infection whether it be from a bacteria it can be from a virus such as the flu or any type of fungal infection. When your body tries to fight it sometimes it over acts and sometimes it can be toxic to your body. What that does is it starts causing problems with your organs. We start seeing different changes in your organs. Sometimes it can be temporary sometimes it can be permanent. But those are usually the symptoms that bring the patients in to the hospital in the first place, that we’re able to access and quickly screen and start treating them for a possible sepsis.
Is this something that happens because of a trauma or is this something that happens out of the blue?
Dorie: There’s not anybody that’s more at risk for it than others except for always the younger people and the elderly. Anybody who is being treated for cancer or anything with long term steroids. But anybody at high risk for infection is at more risk to get it. But there’s nobody that’s going to get it more likely than the other.
I still don’t understand what it is and how it happens.
Dorie: It can occur from anything, from a bug bite all the way up to pneumonia. So if you have a bug bite that there’s been entry in to your system and then there’s some type of bacteria that gets in there that can somewhat cause sepsis. Any type of infection that you have can lead to sepsis.
And what is sepsis, what does it do, what is the process that is happening?
Dorie: Anything the body recognizes that something foreign is coming in to the body it tries to fight it. Sometimes it does well for us sometimes it gets kind of just overzealous. And at the cellular level it starts shutting down our organs it starts causing blood flow not to get to certain organs and then that’s where the treatment of sepsis so quickly becomes so important.
Is this common?
Dorie: It’s very common. At our hospital we see more cases yearly with sepsis than we do with our heart attacks and our stroke. People don’t know about it; when we started this program four years ago we didn’t know that much about it. We knew when people came in with it because there’s a variety of sepsis. There’s sepsis and then it can progress to severe sepsis and then it can progress to septic shock. Septic shock is a complete medical emergency. And those are the patients that we were seeing and we would have a very high mortality rate. So when we started this program four years ago what we realized was there was a whole lot more sepsis and severe sepsis that we that we didn’t really know that we had going in to prior to the awareness.
And this is something that happens all over the country, all over the world actually?
Dorie: Nationwide, it’s a problem with mortality and a lot of people are dying from it every day.
It can kill you?
Dorie: Yes sir. Back about forty years ago nationwide, there was about fifty to seventy percent mortality rate for anybody that came to the hospital with sepsis. And we weren’t really tracking it back then but we know we had a really high mortality rate. And we’ve been able to get our mortality rate down to overall when we combined the two types of sepsis, about twenty percent at this hospital. Last year was a hundred and thirty six lives we saved here with our sepsis protocol so we’re very proud of that.
Only four years ago you kind of became aware that sepsis was a problem?
Dorie: We knew that when we had patients that come in with sepsis they were dying and so we wanted to change that. So we had a very strong heart program and stroke program so we decided to take the initiative to have one person focused on looking at sepsis in general so we were able to change protocols or implement protocols make new order sets, do lots of education. Because what we found is it’s not the quicker they can get treated for it the better their outcomes are. And so what we found is it all begins in the emergency department. So training those emergency department staff to recognize you know they may not come in with a sign on them that says, hey I’ve got sepsis but they may put a couple of key factors together and say, you know this patient may have sepsis. Let’s go and threat them for that now instead of waiting until the patient is confirmed sepsis and then we’re already behind the eight ball that much.
You said four years ago you started the program but that’s not the program really we’re talking about today?
Dorie: Correct.
So you decided okay, we want to get the ER people trained but then you took it a step further?
Dorie: Yes sir. About three years ago when we had everything going and running we actually reached out to our EMS partners in our community. We have a very strong relationship with them and they’re always looking to do the best thing for the patients. So at that point what we did is I just gave them our protocol that kind of said you know, if the patient has this criteria, this patient may have sepsis. And so what they were doing for us at that point was when they were calling on the radio and letting us know that they were bringing a patient they would say, hey this patient meets sepsis criteria so they would activate what we call a code sepsis. At that point they would give IV fluids but that’s kind of all they could do but what they would do is get all hands on deck when the patient got here. And so what we found was when EMS activated a code sepsis we had better numbers in terms of getting their bundle treatment completed quicker than we did if it was just a patient coming in off the street. What they wanted to do is they wanted to take that one step further and they’ve implemented a protocol and partnered with us where when the patient meets that criteria when they were activating the code sepsis instead of just activating they wanted to go ahead and give that first dose of antibiotics after they drew a first set of blood cultures.
The local fire department came to you?
Dorie: The North Richland Hills Fire Department came to me and one of their paramedics had read in South Carolina where some paramedics were starting in the field drawing the first sets of blood cultures and giving that first dose of antibiotics. He wanted to take that one step further and bring it to us. We were able to partner with them and now since March of this year when they activated code sepsis the North Richland Hills paramedics are drawing those two sets of blood cultures for us and giving that first dose of antibiotics.
What’s different now when the paramedics go out in the field what happens?
Dorie: When the paramedics go in the field and the patients they take some criteria like they look at some of their vital signs. They look at their heart rate, temperature, respirations. They look at their entitle Co2 which kind of tells us how well they’re breathing. And what they do is if they suspect any type of infection with that patient, then they can activate from there. If they have a patient that meets the criteria then the paramedics will draw those sets of blood cultures give one dose of antibiotics and then come in route.
Is that the same thing that would happen in the ER?
Dorie: Correct. If you came to the ER as a walk in or if you came in from another paramedic service they would still get two sets of blood cultures, we would give first dose of antibiotics and we do a couple of other blood draws. What they’re doing for us is shaving off two hours of time that by the time the patient comes in the hospital to get registered, before someone would get the vital signs to be able to recognize that this patient may have sepsis but they’ve already taken care of that in the time that it would take them to do registration.
What’s the effect of that two hour jump?
Dorie: Every hour that a patient goes without an antibiotic when they suspect sepsis their mortality goes up seven point six percent. If you think about it, if we give that patient an antibiotic within the first fifteen, twenty minutes of contact of calling a paramedic versus two hours after they come in to the hospital we’re giving them a fifteen percent chance of life more than they had whenever they first came in.
It doesn’t sound like it’s all that big of a deal for the paramedics to do this.
Dorie: A lot people kind of looked at us funny when wanted to do it because the blood cultures are almost a sterile type procedure. What you’re doing when you draw blood cultures is you’re drawing a patient’s blood and you’re putting it in these bottles to see if anything grows out. Whether it’s a bacteria so that you know better what to treat. Because when you first start treating sepsis if you don’t know what the infection is you’re kind of just giving them what we call a broad spectrum antibiotic just to kind of cover anything. But when they come in and they hear from the family member that this patient recently was in the hospital for a urinary staph infection or pneumonia, they can assess and they see maybe like a big wound on the patient. They can kind of determine what they think the infection is and they’ve got two different types of antibiotics that they choose and then they give which one that may be more appropriate for that patient.
How has it be working?
Dorie: It has been working very well. Since we started this protocol in March we’ve had thirty patients that have been brought by them with only a ten percent mortality rate which is phenomenal since in the hospital our overall mortality rate is twenty percent. They bring in the bulk of our patients and so the more patients they bring in and they put in this protocol we’re saving that many more lives.
Would you say that it’s a breakthrough and why?
Dorie: I do believe that this is considered a medical breakthrough for the fact that it is getting these patients the treatment so much faster. Since I’ve been tracking you know all of our information it all comes down to time. Just like a heart attack and stroke, the quicker you get treated the better you do. And it’s the same thing you know time is tissue and with sepsis time is tissue as well. The quicker they get treated the quicker they go home, the less side effects they have. Because once patients with sepsis go home they have a lot problems. There’s some new stuff going on with post-sepsis syndrome but they function better if they get treated faster.
Why does sepsis seem like kind of a new topic, it sounds like it’s something that has been around as long disease and infection has been around.
Dorie: Sepsis has been around forever but I think we’re finally getting the correct term to what it actually is. Instead of people saying you know grandma died from pneumonia a couple of years ago. Grandma probably died from sepsis related to the pneumonia. In the news we’re hearing more because celebrities have passed away from it; Mohammad Ali and all them. That’s getting patients more alert to it. They’re getting taught more about it while they’re in the hospital so their family members are learning more of it. People are more aware of it so therefore I think we are hearing more of it which is very good because four years ago if you said the word sepsis nobody knew what you were talking about. Now somebody kind of knows what you’re talking about. They may not know exactly what it is but they’ve heard of it and they’ve known that someone that may have been sick with it or have passed away from it and want to know more about it.
The numbers show that it can be quite deadly?
Dorie: Yes sir.
You and the whole hospital staff, how does everybody feel about this? I mean it’s really improving people’s chances?
Dorie: The hospital gets very excited whenever we post how well we’ve done with outcomes and mortality. We track everything from how well the emergency department does, how quickly that they treat that patient. They have a competition downstairs we have a board that says, time to treat, time to beat. Whoever gives the antibiotic the faster down there on a patient that’s not a paramedic patient they get real excited about it. At first it’s kind of like any new program or project, just kind of you know okay, we’ve got something new to do. But then they get really excited about it when they hear the numbers of how many patients they treated so well in the emergency department and went home and was able to be time with their family and not have a bad outcome.
And most importantly you’re saving lives.
Dorie: Yes sir.
Talk about that.
Dorie: The most important part of my program I believe is the amount of lives we have saved. Last year we saved a hundred and thirty six total out of the patients we had. And so that you can always have mortality with many types of patients but knowing that you sent a hundred and thirty six people back home with their family is enough reason to keep your program going.
It is a good chance that a certain percentage of those hundred and thirty six people would have died?
Dorie: Yes sir. Without the sepsis protocol there’s a good chance that those hundred and thirty six patients would not have made it.
Did I read that this is one of the first hospitals to actually team up with the local fire department?
Dorie: Yes, this is the first time that a hospital and a fire fighting department has come together. There is another hospital in South Carolina that the paramedics are doing it but we are lucky enough that our fire fighters team up as paramedics too. Whenever you get a call they can do both fire fighters and paramedics. They’re all trained to do the same thing. They are the first fire department in the country and we are the first hospital to partner with them in this protocol.
We’re going to meet some of those guys later and they must feel pretty good about it too.
Dorie: Yes, the paramedics get a lot of satisfaction. They do so much for this community and they are always looking for ways to get people back home. I think it speaks volumes that they actually reached out to us wanting to do this project because it shows their love for the community.
And also their knowledge that time is of the essence.
Dorie: Right. The paramedics are the first hands and eyes on these patients. Their first rapid assessment of that patient is crucial to the treatment and we look at how not every patient that they activate as a code sepsis may be a sepsis patient. Eighty percent of the cases that they brought us last year all had sepsis diagnosis. The twenty other percent all were infectious diagnosis. They could pick up on the fact. They met with their treatment they may have actually helped that patient not go in to a further sepsis just from that rapid treatment.
And if they make a mistake in terms of their assessment I guess there’s no big damage done.
Dorie: Worst case scenario, if they make a mistake and it’s not a sepsis or infectious patient that patient got one dose of antibiotics. If it was my mom or my dad I’d much rather them get one dose of antibiotics and have a better outcome than wish we would have given it a couple hours later.
Right. You told us how every hour makes a difference. And it’s a lot like heart attack and stroke, is that right?
Dorie: Yes sir. The way that sepsis is similar to heart attack and stroke is because of the crucial time. But when you have heart tissue dying, you have brain tissue dying and in your body you have organs dying. And so you know it can be the heart it can be the brain, it could be a lot of times it’s the kidney but the quicker that the treatment that they give that helps so much with it is that antibiotic. They give a lot of IV fluids they’re going to help push blood and stuff back to those organs to keep them from dying.
The sepsis itself it’s not so much an infection of the blood.
Dorie: Correct.
It’s the body shutting down because it’s working so hard.
Dorie: To try to fight the infection. We draw blood cultures on every patient just to see if we can get an identifying bacteria. But over fifty percent of our sepsis cases will never have a positive blood culture. Meaning that it’s not always in the blood. And it’s very rare, it’s less likely to be in the blood than in the blood.
Sepsis I guess helps to explain like for years and years they went in for pneumonia but they died.
Dorie: The current thing that we’re hearing right now is with the current outbreak of the flu. This last month itself in January we had twelve total sever sepsis and septic shock cases and eight of those were all caused from the flu. If you knew anything about sepsis what I would want you to know is that the signs and symptoms of sepsis are just the same as they are of having an infection, the shivering, the rapid breathing, the high temperatures. Sometimes you kind of get confused and not know where you are at. If you have somebody that’s got a wound or have been in the hospital even a bug bite and they start acting funny or showing signs and symptoms of an infection these are patients you want to either take to the ER or call your physician and say, I think my loved one has sepsis.
END OF INTERVIEW
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.
If you would like more information, please contact:
Dorrie Murray
Florence.murray@medicalcityhealth.com
817-255-1354
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