Sepsis is a frequent cause of morbidity and mortality among nursing home residents. A study published in JAMDA used a sample of 31 nursing homes with characteristics similar to nursing homes nationally. The study identified several issues around documentation of active surveillance and medical oversight that may have hindered early detection of sepsis. Particularly noteworthy was the absence of documentation of key status indicators, such as vital signs and cognitive status, and the observation that few nursing home residents received a medical provider visit prior to hospital transfer. It was also noted that the screening criteria for sepsis commonly used in hospital settings appear to perform poorly in the identification of evolving sepsis in this setting.
A prerequisite for effective screening for sepsis in the nursing home is documentation of vital signs and cognitive changes that indicate incipient delirium. Over a quarter of nursing home residents lacked documentation of vital signs in the 72 hours prior to hospital transfer. Better surveillance of persons who undergo changes in status is, therefore, an important element of improved detection of early sepsis.
Particularly noteworthy was the infrequency in which documentation of a visit from a physician, nurse practitioner, or physician assistant during the 72 hours prior to hospital transfer. Well, this is challenging, isn’t it? What can we do to encourage better outcomes? The article goes on to recommend obtaining ongoing vital signs on all residents who staff notice a status change and to use the vital signs to screen for sepsis risk employing the 100-100-100 Early Detection Tool (SIRS criteria, Temperature over 100, Pulse over 100 Blood pressure under 100 or over 40 of baseline) and/or a temperature threshold of 99.0 degrees or greater (or 2 standard deviations above that resident’s normal temperature).