Left: Denise Stromoski, RN (right), works with nurses like Kim Pringle, RN, MSN, CCRN, on the early recognition  of sepsis, the number-one killer in hospitals today.
The VOICE of UPMC Shadyside Fall/Winter 2014

Taking on Sepsis

Shadyside Hospital Foundation helps tackle a little-understood killer

“I am very passionate about sepsis,” says Denise Stromoski, RN, who coordinates the Sepsis Program at UPMC Shadyside. “I became a nurse because I wanted to help people, and I believe that is exactly what this nurse-driven program is doing.”

With funding from the Shadyside Hospital Foundation, Ms. Stromoski has led the development and spread of a comprehensive, patient-focused sepsis intervention system. The goal is to recognize and begin treatment for sepsis within four hours of symptom presentation, when the deadly condition can be more curable. This is important because “sepsis is the number-one killer in hospitals,” says Jennifer Gonzalez McComb, MD, MPH, FACP, chief of Pulmonary Critical Care and a leader of the Sepsis Program. “Sepsis is also the single most expensive condition treated in American hospitals today.”

“All the technology in the world cannot really assess a human like another human can”
- Ms. Stromoski
What is sepsis?

A medical emergency like a heart attack or stroke, sepsis is a serious condition caused by the body’s overwhelming immune response to infection. “Your whole system basically goes into an inflammatory state and starts to attack itself instead of protecting itself,” Ms. Stromoski explains.

Without timely recognition of symptom onset and appropriate treatment with antibiotics, sepsis can progress very quickly to severe sepsis or septic shock, causing organ damage or failure. Death occurs in up to 50 percent of the cases. Those who survive may suffer long-term complications.

“A lot of these patients sometimes end up not being able to return to the same baseline neurological status,” says Ms. Stromoski. “Maybe they are ventilator dependent and cannot breathe on their own. Maybe they now need lifetime dialysis because their kidneys have been destroyed.”

Focused on the patient

At Shadyside, the Sepsis Program is built on nurses’ skill in observing their patients attentively. “Nurses are on the front lines,” says Dr. McComb. “Sepsis can have very subtle changes that occur over time. It really comes down to the nurse and critical thinking skills on assessing the patient.”

“All the technology in the world cannot really assess a human like another human can,” believes Ms. Stromoski, a former ICU nurse.

She began the program by coordinating a hospital-wide, multidisciplinary sepsis committee, which developed evidence-based, protocol-driven orders for intervening. A nurse-driven sepsis screening process was also developed.

Unit by unit, she educated nurses. A Sepsis Team is now available to respond rapidly to a patient’s bedside to provide timely, life-saving interventions, including antibiotics within the first hour of recognition.

“I think we are one of the few institutions that can get antibiotics to patients within this time frame,” says Ms. Stromoski. “I credit that to our phenomenal pharmacy.”

Results so far

“Denise has brought the accepted model of care for septic patients out of the ICU and onto the floors,” Dr. McComb says. “It is a really patient-centered project that isn’t dependent on high technology. It’s just common sense.”

“And the nurses love it because it empowers them,” adds Ms. Stromoski. “They see that they are making a difference with their patients — and that is what nursing is all about. You just want to help people.”

Measurable results so far include a rise in early recognition from 47 to 95 percent, a decrease in mortality from 49 percent to 31 percent, and shorter lengths of stays in the ICU and the hospital.

The Sepsis Program has won several awards at the UPMC Shadyside Quality Fair and received a bronze award at the UPMC System Quality Fair.

The program is spreading to other UPMC hospitals, as well. “At UPMC, we recognize that sepsis must be recognized as quickly as possible,” says Tamra E. Minnier, RN, MSN, FACHE, chief quality officer for UPMC. “I am proud of the work of UPMC Shadyside to raise awareness. This awareness is important because sepsis is a treatable disease, and positive outcomes can result if early detection, antibiotics, and intravenous fluids are initiated quickly.

“But the key to preventing sepsis is to prevent an infection from occurring in the first place,” Ms. Minner emphasizes. “We believe that continued education and the excellent work being done at UPMC Shadyside around sepsis is vital in decreasing septic shock mortality and improving the lives of sepsis survivors.”

As Ms. Stromoski states, “The Shadyside Hospital Foundation has given us the start, like the pebble you toss into the water. The circles will widen.”

Help support the Sepsis Program

Ways To Give