Reducing Sepsis Mortality: Summary
Nicholas Nili
Fresno City College
For years, Sepsis has been the most dangerous and deadly infection a patient can acquire while hospitalized. This can occur from a plethora of primary sources, such as: UTI, wound infection, ventilator associated pneumonia, etc. In this article, “Reducing Sepsis Mortality (2014)”, the author summarizes how nurses can recognize signs and symptoms of sepsis and ways sepsis can be treated and prevented. Due to the fact that many symptoms of Sepsis can be vague and commonly seen in other conditions, it is very difficult for some nurses to identify when a patient is becoming septic. However, as long as nurses are on top of things and frequently monitoring and assessing their patients, sepsis can easily be prevented in most cases. The author emphasizes use of standard order sets for better treatment in sepsis patients, because “Standard order sets use serum lactate values because of the relationship to organ dysfunction in sepsis” (Lopez-Bushneil, 2014). As the use of standard order sets increased, mortality rates in adult ICU patients decreased as well. The author then goes on to discuss that most sepsis cases are seen in the ICU and emergency setting, as well as medical surgical. However, the author believes sepsis cases in the medical surgical setting can strongly be decreased as long as nurses identify signs and symptoms early and notify the physician to initiate the sepsis bundle. Signs and symptoms to be aware of include: “Signs and symptoms of sepsis include fever, chills, altered white blood count, increased C-reactive protein, tachycardia, altered skin perfusion, and reduced urine output.” (Lopez-Bushneil, 2014). The author also briefly touched on the reduction of cost to the hospital and length of hospital stay for the patient, if sepsis is identified and treated early. The Surviving Sepsis Campaign (SSC) created guidelines for treating patients with sepsis and septic shock; publishing 17 recommended actions. Three of these actions are frequently used today in identification and early prevention of sepsis. “These guidelines provide 17 recommendations; the three most frequently used were prompt ordering of cultures, administration of broad-spectrum antibiotics, and deep vein thrombosis prophylaxis. Deterioration of laboratory values is the most common clue to severe sepsis” (Lopez-Bushneil, 2014). The author then goes on to discuss different rates and percentages of sepsis mortality cases including a staggering 21.7% of deaths in a hospital in New Mexico were related to sepsis. In response to this, nurses worked with physicians, rapid response, and other healthcare workers to develop a sepsis protocol in different med-surg units as well as a sepsis screening tool (pictured in the article) in order to help prevent and manage sepsis before it gets too severe. The author then touched on how the CQI model “The Institute for Healthcare Improvement (IHI) Model used for this program included setting aims, forming teams, establishing measures, and selecting and testing changes” (Lopez-Bushneil, 2014). Following this, the sepsis bundle was mentioned, discussing a revision to the severe sepsis bundle to include three and six hour resuscitation and septic shock bundles. The author states that the 3-hour bundle includes measurement of: lactate levels, blood cultures, broad spectrum antibiotic administration, and infusion of crystalloid for hypotension in septic patients. Following this, the 6-hour bundle would include measurement of central venous pressure and oxygen, as well as lactate levels as needed. In order to reach the ultimate goal of reducing sepsis related patient death, the Sepsis Mortality Improvement Team (SMITe) established the importance of recognizing “patients with systemic inflammatory response syndrome (SIRS) in response to infection and associated with acute organ dysfunction at the earliest possible stage” (Lopez-Bushneil, 2014) in order to differentiate the levels and aggressiveness of treatment patients would need, depending on the severity of the condition. SMITe’s method, however was unique from others because it focused more so on the medical-surgical aspect of care as opposed to the ICU side. “Medical-surgical units were chosen because nurses in those areas are the primary responders to deterioration. The sepsis bundle comprises basic care elements that can be delivered in these areas as well as more complex tasks requiring critical care” (Lopez-Bushneil, 2014). They also found that rapid infusion of antibiotics as well as fluids via intravenous route within the first hour can reduce patient mortality by 30-50%. There was also a great image included in this part of the article showing an example of verbal telephone orders, showing examples of progressing through sepsis screening. The author then discusses how a nursing unit manager was approached to initiate this evidence based sepsis project on the unit. Nurses on this unit were introduced to “the Surviving Sepsis Guidelines developed by the European Society of Critical Care Medicine and the Society of Critical Care Medicine” (Lopez-Bushneil, 2014). Nurses on this unit took a four hour education course with the goal of improvement on sepsis diagnosing, managing, and patient survival rates. Tools were created and fine-tuned patient after patient until the correlation between the two reviewers was 0.8 or higher. These two reviewers were nurses who recognize signs and symptoms of sepsis and recommended initiation steps to the sepsis bundle. This led SMITe to help by creating tools to assist staff including: “A sepsis screening tool that allows nurses to review sepsis- related symptoms, outlined steps (bundle) the nurse must take in caring for patient with suspected sepsis, an electronic sepsis order set, verbal order telephone scripts to support communication between the physician and nurse, complete protocol” (Lopez-Bushneil, 2014). This led all med-surg patients to be screened during every shift as well as proper laboratory tests to be drawn (lactate and blood cultures); antibiotics also began to be administered 1 hour within order creation. Following this portion of the article is a page long, complete sepsis protocol sheet detailing what to do during certain steps of sepsis and sepsis screening. Following this, the article touches on SMITe continuing to review the efficiency of existing protocols for sepsis screening, on a monthly basis. During the first two years of the SMITe initiative in UNMH (New Mexico hospital), 225 “225 adult patients screed positive for sepsis; less than 112 deaths occurred, representing a 50% decrease in mortality” (Lopez-Bushneil, 2014). This process has also led to greater nurse satisfaction, increasing from 72% to 78%, because this protocol enables nurses to be proactive and identify symptoms of sepsis, order the proper tests in a timely manner, and initiate the protocol, hopefully saving a life. “Results of this project indicated nurses can make a significant contribution to patient care by identifying problems, reviewing the literature, and initiating evidence-based protocols” (Lopez-Bushneil, 2014).
References
Lopez-Bushneil, K., Demaray, W. S., & Jaco, C. (2014). Reducing Sepsis Mortality. MEDSURG
Nursing, 23(1), 9-14.