Episode 159

Nursing home sepsis and septic shock

 

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Sepsis is consistently in the top ten causes of death every year. Why are nursing home residents susceptible to sepsis and septic shock? When is a resident who has been hospitalized or killed by sepsis allowed to sue a nursing home? In this week’s episode, we talk about this nursing home sepsis cases in Georgia. 

Nursing home sepsis deaths are common

So sepsis continues to be in the top 10 for leading cause of death in both Americans overall as well as Georgians and one of the top 10 or higher causes of death for our nursing home resident population. We have gone into some depth on sepsis in previous episodes – if you want to check those out as well. Episode 79, we had Dr. Imrana Malik talking about how to prevent sepsis in Georgia nursing homes and then we had Richard Mollot in Episode 143 just talking about general infection controls in nursing homes.

What is sepsis? 

So one of the main takeaways for this episode is that it’s the idea that sepsis really isn’t an infection in itself. Sepsis is the body’s reaction to an infection. So oftentimes a nursing home resident will start off with some type of localized infection, so pneumonia, a UTI, perhaps some type of infection due to a wound like a pressure ulcer is very common that there’s an infection, bacteria located in a wound. So what happens is that the body essentially overreacts so to speak, more or less, to that localized infection. 

And what’s interesting is that despite being one of the leading killers of Americans, in particular nursing home residents, we’re actually still learning about sepsis and septic shock. It’s not something that we’ve come to grips with or have the most amount of data, techniques, which is surprising, but that’s how it works. But sepsis and septic shock, again, is a reaction to infection and we kind of view it, we rate it on a scale. 

How does sepsis progress to septic shock?

So at the beginning of the progress of sepsis, you have what’s called SIRS, which is Systematic Inflammatory Response Syndrome. This is basically the first stage in the progression of the illness. That’s where the body begins to become inflamed, like the tissues in the area of the infection become inflamed and start reacting to actual initial infection. Then we get into what we are categorizing as sepsis. The individual continues on their progression to becoming inflamed in that local area and the body begins to react to it more. And this is the point where we say the person has become septic. Then on the scale we have what’s called severe sepsis. Severe sepsis is where we have inflammation and now we have problems with blood circulation. And at this point, you begin to see problems with organ function. The final stage on the spectrum is septic shock, and this is where the body has now completely begun to shut down. Organ failure is quite common with septic shock. In fact, if you have made it to septic shock on the scale, then the mortality rate skyrockets. At this point, I believe it’s still something like 50 percent mortality rate for people suffering from septic shock. So it’s not just sepsis or not sepsis. There’s kind of a spectrum ranging from SIRS all the way to septic shock, and where you are on that spectrum will depend on how inflamed and how much of a response your body is giving to that infection.

How does sepsis in nursing homes occur? 

So again, sepsis occurs in nursing homes most often, at least in my anecdotal research and my experience as a nursing home lawyer. Sepsis and septic shock occurs as a result of pneumonia, UTI and pressure ulcer infections. Those are going to be the main drivers of whether or not somebody is getting sepsis. To a lesser degree, other infections can do it as well, so MERSA can be the cause, gram-negative bacilli, but again, it’s most often that trinity of pneumonia, UTI and pressure ulcers. Why is that so? I don’t have an answer for that. Perhaps these three infections are more common than others. I don’t know but from what I see, that’s typically what’s causing people to get to the emergency room, it’s one of those three.

How can nursing homes prevent sepsis and septic shock?

How can nursing homes prevent sepsis and septic shock in nursing home residents? I will not get into infection control protocols. Like I said, Richard Mollot talked about that with us in Episode 143. We talked about infections in Episode 98 as well on preventing infections. There are several buckets we can talk about in terms of preventing sepsis. In doing reasonable actions, taking reasonable actions to prevent infections to begin with is going to be the primary way we can prevent sepsis in nursing homes. Federal regulations require infection control protocols, so having a hand hygiene in place so staff know when and how often and under what circumstances to wear PPE or to wash their hands, clean equipment, how often to clean equipment, just basic common sense things to prevent infections. And preventing infections, which is how sepsis starts as a reaction to the infection, that can obviously go a long way to preventing sepsis.

Training on the signs of nursing home sepsis can save lives

But setting aside infection control protocols as a way to prevent sepsis, one of the principal ways, the main way that a nursing home can prevent sepsis or septic shock from killing a resident is for the nursing home to train staff on the signs and symptoms of septic shock, signs and symptoms along that spectrum from SIRS all the way to septic shock. So if a resident has already had a history of infection, they should be in a category of “let’s watch out for this,” because essentially we know that a resident is entering that first stage of sepsis, SIRS, the Systematic Inflammatory Response Syndrome, if there has been in the past a UTI, pneumonia, pressure ulcer, some type of previous infection or suspected infection along with two other symptoms. And those symptoms are altered mental state, lowered blood pressure or rapid breathing. And altered mental status just means if the resident is uncharacteristically lethargic, if they’re acting confused, if there’s some type of loss of capacity that is not baseline for that resident. 

So again, if you’ve got either a previous or suspected infection and then you have at least two of these symptoms – altered mental status, lowered blood pressure or rapid breathing – then you are considered to be in at least that first stage of sepsis and therefore sepsis protocols should be taken by that nursing home.

What are nursing home sepsis protocols?

So sepsis protocols at minimum are going to be alerting the primary care physician or alerting the attending physician. “Dr. Smith, we’ve observed Mrs. Johnson since early this morning has not been talking as much. She’s kind of staring into space. It’s not baseline for her. And remember that we’re treating her for UTI.” So that’s the first step, alerting that physician so the physician can fax in or telephone in orders.

Next thing is – and again, the orders will probably run labs, but the next thing to do is to run labs. So you’re testing for infection, trying to get that under control, finding out what’s going on. You begin to document all systems. The nursing home staff should take all vitals – respiration, blood pressure, heart rate, these types of things. And then if it appears that the resident is continuing on that spectrum, then you send the resident out for more stringent sepsis protocols at an acute care hospital.

So again, the main thing is training staff to be observant of the signs and symptoms, the early signs and symptoms of sepsis is going to do the most help in preventing severe injury from sepsis.

Can you sue a nursing home? 

So can you sue a nursing home for death or for severe injury from sepsis? And the answer is yes. Typically we see these cases kind of divided into a couple of categories. The first category is oftentimes the negligence or the breach in standard of care or the reason why the lawsuit should be brought is from the infection to begin with. So did the nursing home so all they could under standards of practice and the federal regulations to prevent a bedsore, for example? And if they didn’t, then they’re responsible for the resulting complications from that bedsore, which includes sepsis. So in that one bucket, you’ve got, okay, they were negligent in causing the underlying infection anyway.

Sometimes you have residents that you could do whatever – you could follow all the protocols, which is assessing the resident, developing a care plan based on that assessment and revising that care plan as needed, and the resident would still develop a UTI. So situations in which the nursing home is “doing everything it can” and the infection is unavoidable and still occurs, there still can be a case if that infection leads to sepsis if the nursing home did not follow the standard of care with regard to observing the signs of sepsis and treating it quickly. So that’s the second bucket we see in these sepsis cases is even though the infection is not “the fault” of the nursing home, the nursing home missed the fact that Ms. Johnson’s mental status had fallen and that she had a UTI or pneumonia. 

What makes a sepsis case strong?

These cases are sometimes not as cut and dry, not as simple as other cases like falls, and the reason is because the body works sometimes in mysterious ways and you’re dealing with an internal injury, internal disease that’s the result of an infection unlike a fall where you can say, “Well she didn’t have a broken elbow before she rolled out of bed and hit the ground.” That’s kind of a more easier causal connection between the incident, which is the fall, and the injury, which is the broken elbow. With sepsis, you’re dealing with a whole lot of moving parts within the body and whether or not the nursing home, if they would have done what they should have done, whether or not it would have happened anyways. 

Not to say these cases are impossible – we take on sepsis cases all the time, but that’s the main thing is that if the nursing home failed to properly prevent the infection or failed to observe the signs and symptoms of sepsis in time, and in fact because of those breaches of the standard, the resident in fact developed sepsis or septic shock and was injured, then there was a case, absolutely. And as we’ve discussed in other episodes, the damages from these types of cases will depend on the severity of the injury. 

But again, at the end of the day, like I said, sepsis itself is not an infection. It’s the body’s reaction to an infection. We’re still learning a lot. Unfortunately this illness is causing a lot of death in this country. We’ve got a lot to learn about it. But I just wanted to make everybody aware of it because I feel it’s not something that’s known. I have a 78-year-old mother that I tell her when she had pneumonia and I said, “Okay,” – obviously she lives with my sister and my nieces and nephews and I said, “Okay, we’ve got to watch for these signs, like Mom, are you going to take your temperature? You’ve got to make sure you tell my nieces and nephews to watch out in case you’re not feeling up to it one day because these could be the initial signs of sepsis.” But she had no idea. She had never heard of sepsis before. It’s just not something that is common knowledge and that is kind of the point of this episode is I just want to get this out there into the ether to educate people on this condition.

But if you found this episode informative, please like and subscribe. Be sure to reach out to us if you have some type of subject matter you’d like us to address. If you have a loved one in a nursing home and maybe they’re doing X, Y and Z and you want us to talk about that, we’re more than happy to. Reach out to us. The Nursing Home Abuse Podcast comes out every other Monday. You can find us on YouTube or wherever you get your podcast from. And with that, we’ll see you next time.

 


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