Cedars-Sinai Medical Center

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New FDA alerts

Pharmacy focus

The U.S. Food and Drug Administration issued updates and warnings for phenytoin, fosphenytoin, dronedarone, aliskiren and other drugs.

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Physician news

David Rimoin, MD, PhD, named an American College of Physicians master, Ilana Cass, MD, selected for the Executive Leadership in Academic Medicine fellowship, a Kawasaki disease study by Moshe Arditi, MD, honored at conference, and Robert H. Baloh, MD, PhD, received ALS Association award.

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Meetings and events

Grand rounds

Click here to view upcoming Grand Rounds.

Upcoming CME conferences

Click below to view a complete list of all scheduled Continuing Medical Education conferences.

CME Newsletter - May 2012 (PDF)

Share Your News

Won any awards or had an article accepted for publication? Share your news about professional achievements and other items of interest.

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Calling Code Sepsis

New protocol reduces mortality in septic inpatients

A new sepsis protocol to administer appropriate antibiotics within the first hour of the onset of sepsis is already producing dramatic results at Cedars-Sinai.

Patients for whom the Code Sepsis protocol was used had a mortality rate that was significantly lower than that of patients for whom the protocol was not used. The mortality index for Code Sepsis patients dropped from a baseline of 1.67 to 1.0, according to the Cedars-Sinai Medicine Task Force that created and implemented the Code Sepsis protocol.

"This is the first initiative of Cedars-Sinai Medicine to demonstrate an actual decrease in mortality," says Glenn B. Braunstein, MD, vice president of Clinical Innovation. "We are extremely pleased with the results so far and now our challenge is to increase usage of the protocol."

Task force members launched Code Sepsis earlier this year after conducting a detailed analysis of the guidelines set out in the Surviving Sepsis Campaign, a global effort led by the Society for Critical Care Medicine, to reduce deaths from severe sepsis and septic shock. Sepsis has been ranked as the 10th-leading cause of death in the U.S.

"Research has shown that antibiotics given in the first hour is the most important measure to improving outcomes," said Heather Jones, MD, co-chair of the task force. "Mortality increases significantly with every hour of delay."

The goal of Code Sepsis is to ensure that blood cultures are drawn promptly and that the first doses of antibiotics are given to patients in under one hour. The antibiotic selection is derived from the CSMC Empiric Antimicrobial Treatment Guidelines and the protocol is a multidisciplinary approach that involves the nursing, pharmacy and even phlebotomy staff.

When a physician identifies a potentially septic patient, he or she uses the Code Sepsis order set to order antibiotics, fluids and appropriate labs. The physician then verbally notifies an RN that a Code Sepsis has been initiated. Alternatively, an RN can activate the process by alerting a physician that there is a patient exhibiting new signs concerning for severe sepsis.

The RN immediately pages a pharmacist, who then reconciles antibiotic orders and promptly hand-delivers the antibiotics to the floor. Some antibiotics, like Zosyn, are now in the Pyxis as part of this initiative. The RN then draws cultures and labs and, within one hour, hangs the antibiotics.

"Like a Code White or a Code Brain, time is of the essence in these patients," said Phil Zakowski, MD, co-chair of the task force.The protocol has reduced the average time of delivery of the initial dose of antibiotics from 211 minutes (about 3.5 hours) to 69 minutes.

"Nursing and Pharmacy have done an incredible job in meeting this one-hour goal," Zakowski said.