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Hospitals Would Have to Implement Protocols, Train Staff

Under a proposed rule published in the New Jersey Register today, hospitals would be required to establish, implement and periodically update evidence-based protocols for the early identification and treatment of patients with healthcare-acquired and community-acquired sepsis, and septic shock.

The proposed rule, which is open for public comment through August 18, would also require hospitals to train staff in the protocols they establish.

Sepsis, a life-threatening but sometimes overlooked complication of infection, is the most expensive condition treated in U.S. hospitals and the second most common cause of hospitalization nationally, according to the U.S. Agency for Healthcare Research and Quality.

“While sepsis protocols have been an increasing focus of New Jersey hospitals, we know early identification and prompt treatment of sepsis is critical to survival,” New Jersey Health Commissioner Cathleen D. Bennett said. “Every minute counts. Sepsis is treatable if addressed as a medical emergency.”

Hospitals would implement and train staff so that when a condition is not readily identified, they can ask, “Could it be sepsis?” In addition to the new rule proposal, the Department of Health will develop a public education campaign to make families aware of the condition so they can also ask health providers this question. About 45 percent of Americans say they are not aware of sepsis, according to a survey by Sepsis Alliance. 

Sepsis is a complication caused by the body’s overwhelming and life-threatening response to infection, which can lead to tissue damage, organ failure and death. It is difficult to predict, diagnose and treat, according to the Centers for Disease Control and Prevention (CDC). Read personal stories on sepsis at CDC’s Safe Healthcare Blog.

Sepsis was the seventh leading cause of death in New Jersey in 2015, when about 2,100 people died of sepsis. The state’s sepsis mortality rate, which was about 20.7 per 100,000 in 2015, has been trending upward from 19.4 per 100,000 in 2011.

There is no single sign or symptom of sepsis. It is a combination of symptoms. Since sepsis is the result of an infection, symptoms can include infection signs (diarrhea, vomiting, sore throat, etc.), as well as any of these symptoms: shivering or fever, extreme pain or discomfort, clammy or sweaty skin, confusion or disorientation, shortness of breath or high heart rate.

Anyone can develop sepsis from an infection, especially when not treated properly. However, sepsis occurs most often in people aged 65 years or older or less than 1 year, those who have weakened immune systems or have chronic medical conditions like diabetes.

The New Jersey Hospital Association (NJHA) created a Sepsis Learning and Action Collaborative, and as a result, hospitals across the state implemented life-saving sepsis detection and care tools that resulted in nearly 400 lives saved in one year of action. Results showed reduced severe sepsis mortality by about 11 percent, an increase in the use of hospital-wide sepsis screening tools from 20 to 70 percent, and increased adoption of hospital-wide sepsis protocols from 40 to 90 percent, among other positives.

The Certificate of Need and Healthcare Facility Licensure Program is proposing the rule within the Infection Control subchapter of the Hospital Licensing Standards at N.J.A.C. 8:43G-14.9. The Health Care Administration Board has approved the proposed rule. For more information about sepsis, visit cdc.gov/sepsis. 

Those wishing to comment on the proposal must submit written comments either electronically by August 18, 2017 to https://nj.gov/health/legal/ecomments.shtml or by regular mail postmarked on or before August 18, 2017 to Genevieve Raganelli, Regulatory Officer, Deputy Administrative Practice Officer, Office of Legal and Regulatory Compliance, Office of the Commissioner, NJ Department of Health, PO Box 360, Trenton, NJ 08625-0360.

LexisNexis offers free online access to the New Jersey Register at http://www.lexisnexis.com/njoal.  An unofficial copy of the proposal is available from the Department’s website at https://nj.gov/health/legal/rules/notice-of-rule-proposals/. 

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For more information, visit our homepage at nj.gov/health.