Sepsis Essay

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New Sepsis Guidelines and Nurses: Factors, Compliance and Consideration

Introduction to Sepsis



Sepsis refers to the body’s dangerous reaction to an existing infection. Sepsis is extremely serious and if not treated swiftly with appropriate action it can lead to fast tissue and organ damage and death. The medical community has long been focused on getting better control of sepsis, as it is a damaging and debilitating condition that contributes to a host of preventable deaths. In fact, sepsis is one of the primary reasons for death in the number of hospitalized patients and is the cause of 20% of all admissions to intensive care units. (Ferrer et al., 2008). This data clearly indicates that sepsis is an aggravated problem that experts need to have better protocol for and preventative measures to counteract. In America, the rate of death from sepsis is one of the highest rates in the world with a mortality rate almost as high as 30% (Ferrer et al., 2008). This paper examines the new sepsis guidelines and all factors connected to these guidelines, such as the factors that provoked new guidelines, who the new guidelines impact the most, what this means for clinicians, and to what rate of success nurses and other healthcare professionals have been successful in implementing these new guidelines. Nurses are at the front lines of patient care and can often have a more powerful impact on patient wellness than physicians. This paper will review all relevant literature connected to sepsis guidelines, and seek to determine what needs to more aggressively change in the medical community in order to drastically minimize the rate of occurrence.

Considerations



Most healthcare professionals are aware of the benefit of educational programs and interventions like the Surviving Sepsis Campaign (Rhodes et al., 2016). Campaigns like the Surviving Sepsis Guidelines offer just under 100 suggestions on the immediate management and resuscitation of patients with sepsis or septic shock; from this group the strongest recommendations were selected for the most excellent care of patients with this condition. Though it is important to note that not all clinicians support the implementation of new sepsis guidelines and methods; some believe that changes, which are too radical, could actually undermine efforts to stop or prevent sepsis (Simpson, 2016).



However, it’s important to engage in a thorough literature review on the subject since sepsis mortality and manifestation rates are still robust. Even though many clinicians have been subjected to the rigors of such educational movements such as Surviving Sepsis, there are still gaps in understanding why these interventions aren’t more effective. It’s definitely possible that many of the educational interventions, programs and campaigns have been too rigorous for the fast-paced and high stakes world of professional healthcare, medicine and the emergency department. It’s also possible that despite the educational attempts at sepsis care and prevention with clinicians, the knowledge might be there, however there still might be gaps in understanding. Hence, the more rigorous the literature review is, the more it will shed light on the practical improvements that need to be made in the case of this debilitating issue.

Literature Review



The article, “Improvement in Process of Care and Outcome After a Multicenter Severe Sepsis Educational Program in Spain” by Ferrer and colleagues seeks to determine how closely clinicians are following the new sepsis guidelines. This paper posits that better training and education can help bridge any gaps in understanding by ensuring that clinicians are all on the same page with the best practices. However, the authors of this study wanted to determine how effective such an educational program was on daily practices. This study examined 854 patients and engaged in a rigorous intervention with doctors and nursing staff from the ER department. Ultimately the study found that the educational intervention manifested in improved compliance, but not total compliance (Ferrer et al., 2008).

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In a similar fashion, Kleinpell and associates sought to determine the overall role of the nurse and the entire nursing department in the treatment of sepsis care, in the study, “Implications of the New International Sepsis Guidelines for Nursing Care” (2013). In this article, the authors highlight how serious sepsis is and how even in recent times it has remained a pressing concern, despite efforts to manage this condition better with aggressive preventative efforts. Kleinpell and colleagues address the new guidelines for the management of this condition to better minimize it for both adult and child patients. Nurses are at the front lines of patient care, but critical care nurses are even more pivotal at prevention efforts as they have immediate involvement with evaluating patients who are particularly vulnerable for sepsis and with those who are already afflicted. Kleinpell and colleagues highlight how and why its so important for nurses to follow guidelines as they can impact the most change and improvement in patients. “Nurses’ knowledge of the recommendations in the new guidelines can help to ensure that patients with sepsis receive therapies that are based on the latest scientific evidence” (Kleinpell et al., 2013). The authors highlight some of the most important protocols to prevent and treat sepsis, continually connecting it back to the pivotal role of nurses.



Similarly, Kleinpell’s later work returns to these same themes, in the research study “Targeting Sepsis as a Performance Improvement Metric” (Kleinpell & Schoor, 2014). This study focuses as well on the critical role the nurse plays in controlling, preventing and treating sepsis. In particular, this study finds that specific performance improvement methods directed at early recognition and specific treatment can improve sepsis care through the professional excellence and responsibility of the nurse.

Focusing on the responsibility of the nurse is a wise decision when it comes to successfully treating and thwarting sepsis in patients of all ages. The study, “Nursing considerations to complement the Surviving Sepsis Campaign guidelines” by Aitken and colleagues (2011) sought to fine-tune the current sepsis guidelines based on current evidence in order to guide clinicians to offer the best patient care in treating aggravated or minor sepsis. At the end of this study, “Sixty-three recommendations relating to the nursing care of severe sepsis patients are made. Prevention recommendations relate to education, accountability, surveillance of nosocomial infections, hand hygiene, and prevention of respiratory, central line-related, surgical site, and urinary tract infections, whereas infection management recommendations related to both control of the infection source and transmission-based precautions” (Aitken et al., 2011). This study shows that preventing and minimizing sepsis is a truly involved process, one that has numerous aspects and requires the utmost professional excellence.



For pediatric cases of sepsis, there needs to be an aggressive strategy in place, to minimize mortality. This was the focus of the research study, “Implementation of Goal-Directed Therapy for Children With Suspected Sepsis in the Emergency Department” by Cruz and colleagues (2011). This study particularly targeted the proper strategy for use in ERs when identifying septic shock, adding that symptoms such as slower recognition and incomplete fluid resuscitation were common. These researchers highlighted the importance of a computerized triage system, which set off an alarm whenever the vital signs of the child became abnormal. Such a technological tool can pinpoint sepsis faster and help facilitate time-sensitive interventions (Cruz et al., 2011).

However, so many of the sepsis guidelines are in place to prevent sepsis and to minimize the infection if it does in fact manifest. The research study “Adherence to PALS Sepsis Guidelines and Hospital Length of Stay”….....

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References

Aitken, L.M., Williams, G., Harvey, M., Blot, S., Kleinpell, R., Labeau, S., Marshall, A., Ray-Barruel, G., Moloney-Harmon, P.A., Robson, W. and Johnson, A.P., 2011. Nursing considerations to complement the Surviving Sepsis Campaign guidelines. Critical care medicine, 39(7), pp.1800-1818.

Burney, M., Underwood, J., McEvoy, S., Nelson, G., Dzierba, A., Kauari, V. and Chong, D., 2012. Early detection and treatment of severe sepsis in the emergency department: identifying barriers to implementation of a protocol-based approach. Journal of Emergency Nursing, 38(6), pp.512-517.

Cruz, A.T., Perry, A.M., Williams, E.A., Graf, J.M., Wuestner, E.R. and Patel, B., 2011. Implementation of goal-directed therapy for children with suspected sepsis in the emergency department. Pediatrics, 127(3), pp.e758-e766.

Daniels, R., Nutbeam, T., McNamara, G. and Galvin, C., 2010. The sepsis six and the severe sepsis resuscitation bundle: a prospective observational cohort study. Emergency Medicine Journal, pp.emj-2010.

Ferrer, R., Artigas, A., Levy, M.M., Blanco, J., González-Díaz, G., Garnacho-Montero, J., Ibáñez, J., Palencia, E., Quintana, M., de la Torre-Prados, M.V. and Edusepsis Study Group, 2008. Improvement in process of care and outcome after a multicenter severe sepsis educational program in Spain. Jama, 299(19), pp.2294- 2303.

Gauer, R.L., 2013. Early recognition and management of sepsis in adults: the first six hours. American family physician, 88(1).

Kleinpell, R. and Schorr, C.A., 2014. Targeting Sepsis as a Performance Improvement Metric Role of the Nurse. AACN advanced critical care, 25(2), pp.179-186.

Kleinpell, R., Aitken, L. and Schorr, C.A., 2013. Implications of the new international sepsis guidelines for nursing care. American Journal of Critical Care, 22(3), pp.212-222.

Paul, R., Neuman, M.I., Monuteaux, M.C. and Melendez, E., 2012. Adherence to PALS sepsis guidelines and hospital length of stay. Pediatrics, 130(2), pp.e273-e280.

Paul, R., Melendez, E., Stack, A., Capraro, A., Monuteaux, M. and Neuman, M.I., 2014. Improving adherence to PALS septic shock guidelines. Pediatrics, 133(5), pp.e1358-e1366.

Robson, W.P. and Daniels, R., 2008. The Sepsis Six: helping patients to survive sepsis. British journal of nursing, 17(1), pp.16-21.

Rhodes, A., Evans, L.E., Alhazzani, W., Levy, M.M., Antonelli, M., Ferrer, R., Kumar, A., Sevransky, J.E., Sprung, C.L., Nunnally, M.E. and Rochwerg, B., 2017. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Intensive care medicine, 43(3), pp.304-377.

Simpson, S.Q., 2016. New sepsis criteria: a change we should not make. Chest, 149(5), pp.1117-1118.

Tromp, M., Hulscher, M., Bleeker-Rovers, C.P., Peters, L., van den Berg, D.T., Borm, G.F., Kullberg, B.J., van Achterberg, T. and Pickkers, P., 2010. The role of nurses in the recognition and treatment of patients with sepsis in the emergency department: a prospective before-and-after intervention study. International journal of nursing studies, 47(12), pp.1464-1473.

Wang, Z., Xiong, Y., Schorr, C. and Dellinger, R.P., 2013. Impact of sepsis bundle strategy on outcomes of patients suffering from severe sepsis and septic shock in china. Journal of Emergency Medicine, 44(4), pp.735-741.
 
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