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Pharmacy Practice in Focus: Health Systems
The agency outlines key elements for building effective hospital sepsis programs.
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Sepsis is the most common cause of hospital-associated death, with mortality rates between 24% and 35% at 30 days.1,2 The significant heterogeneity of sepsis, changing definitions, and diagnostic coding make it difficult to accurately measure trends and demonstrate areas of improvement.3 Some studies have reported stagnant mortality rates over time, representing an unmet health care need.2 The CDC published Hospital Sepsis Program Core Elements in 2023, which defined recommended components of hospital-based sepsis programs.4 This review will outline the core elements and additional considerations when building or optimizing hospital-based sepsis programs.
Hospital Leadership Commitment
Similar to the CDC’s Core Elements of Antimicrobial Stewardship, the first priority for a successful sepsis program is hospital leadership commitment. This includes providing sepsis leaders with dedicated time to manage the program, allocation of resources for the program, and communication with staff regarding program needs.
Accountability
The appointment of a leader to manage the sepsis program and oversee the outcomes, specifically a nurse and physician co-lead, is strongly recommended. If the sepsis program is co-led, there should be a clear delineation of responsibilities. These leaders are responsible for goal setting, progress monitoring, and revision. Pharmacists are not identified as recommended leaders at this time, but committee involvement may lead to more leadership opportunities.
Multiprofessional Expertise
Having a multidisciplinary team with a dedicated sepsis coordinator can positively impact the outcomes seen with patients with sepsis. Clinicians from various disciplines and departments such as the emergency department, pharmacists, and intensive care units should be included in the collaborative efforts.
Notably, the notion that antimicrobial stewardship may hinder sepsis care is a misconception. Antibiotic stewardship plays a significant role in therapy optimization leading to better patient outcomes, with 1 study showing an improvement in time to first antimicrobial of 37 minutes.5
Action
Sepsis programs need to take action to improve patient outcomes. Quality improvement strategies such as PDSA (plan, do, study, act) and change management principles can help guide the development and implementation of program initiatives.6 Examples of action include standardizing sepsis screening, sepsis treatment (eg, order sets), and hospital guidelines or algorithms. Artificial intelligence and machine learning may provide additional opportunities in the future for health systems to facilitate early identification and treatment of sepsis.7
Tracking
Applicable, accurate, and timely data are essential to defining the current state and developing program goals. Sepsis programs should identify key goals and metrics to help focus efforts and drive quality improvement. Tracking can also require significant resource investment and therefore should be focused on the program goals and desired patient outcomes.
There are several categories of tracking, as follows:
Reporting
Reporting sepsis metrics, patient outcomes, and the impact of changes implemented by the sepsis program is an essential component of maintaining staff engagement. Reporting will instill confidence in process changes and reinforce best practices established by the program. Recipients of reports should include hospital leadership, unit leaders, clinicians, and nursing. Information presented should also include observed trends, outcome definitions, description of how data were collected, an assessment of the results, and any action taken in response to the data. Further, it is important to ensure reports are tailored to different stakeholders and relevant to the unit or providers receiving the information.
Dashboards and regularly generated reports can further simplify the process, which can make routine reporting easier. Focused case reviews and root cause analyses can help identify specific areas for improvement and provide constructive feedback. Positive reinforcement of desired behaviors can improve the impact of the program.
Education
Sepsis education should be aimed at both health care workers and patients. All health care workers involved in the care of patients with sepsis should be educated on the importance of timely intervention and treatment. This may include but is not limited to providers, nurses, pharmacists, and health care professional trainees. Educational strategies should be diverse and include a range of avenues such as email, newsletters, and case-based simulations. Patient education should include education on ongoing risk and early identification of complications so that medical intervention is sought early when necessary.
Alyssa Christensen, PharmD, BCIDP, is a lead Infectious diseases and antimicrobial stewardship pharmacist at HealthPartners in Minneapolis, Minnesota.
Yosef Nissim, PharmD, MBA, BCIDP, is a PGY-1 pharmacy residency program director and infectious diseases clinical pharmacy specialist at Ocean University Medical Center in Brick, New Jersey.
While education is essential, it may not be the most effective method of implementing sustained changes. The Institute for Safe Medication Practices categorizes education as one of the least effective methods for reducing risk.8 A well-rounded sepsis program should include education as a core tenet alongside other interventions.
Conclusion
The CDC’s Hospital Sepsis Program Core Elements highlight the importance of monitoring and optimizing sepsis care. The guidance closely resembles that of the CDC’s Core Elements of Antimicrobial Stewardship, making the structure familiar to many.
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