I chose an article from the Journal of Emergency Nursing, called improving 3-hour sepsis bundled care outcomes: implementation of a nurse-driven sepsis protocol in the emergency department. I can relate to this particular article because I work in a rural ER and we have long wait times. Most interventions must be completed in the ER, because we can sit on patients for several days due to transportation and etc. It was neat to see a study about nurse driven bundles and how they effect patient care. I hope you enjoy the article and can use it in your practice.
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Hello Nicole,
I work in OB and we do 5000/yr. Sepsis is something we see infrequently, not rare, but not all that often. I find on our unit we have lots of complications with hypertension, hemorrhage and we have safety bundles in place and protocols that are followed well but sepsis is not one of our strong points on the OB floor. I find it a bit scary, probably because I don’t have a good grasp on it, esp. how to recognize early since there are so many other things we are looking at with pregnant mother. In researching this topic I read “Sepsis and septic shock in pregnancy: Early identification of sepsis is critical to identify the source of infection, maintain perfusion, and initiate appropriate antibiotic therapy: It referred to the way I feel by saying “recognition and management of sepsis and septic shock in pregnant women remain a challenge, despite several advances made in the non-pregnant patient population. The article presented stats that 12.7% of maternal mortality in the U.S. are due to sepsis and the 3rd leading cause of death with increasing numbers. I looked at my hospital and I could not find a protocol but I did find in an order set, a safety bundle with the 3 hour and 6 hour mark much like your research talked about. We handle most things on our unit but sepsis is one we do send to ICU. Even though we will transfer our patients off it is still of utmost importance that we as nurse learn to recognize early signs. Do you keep OB patients or have an OB unit at your rural hospital? OB patients are not ones you can keep with you in the ER for three days. Do you life flight out? I work in KC metropolitan area but live in med. size town of 35,000. We have 2 community hospitals of about 75 beds and both have closed their OB wards. I’m thinking if this septic mother shows up at the community hospital without an OB unit, care would not be optimal.
Martin, S., & Barid, S. M. (2018, June). Sepsis and septic shock in pregnancy. Early identification of sepsis is critical to identify the source of infection, maintain perfusion, and initiate appropriate antibiotic therapy. Contemporary OB/GYN, 63(6), 10+. https://link-gale-com.ezproxy.fhsu.edu/apps/doc/A548028861/AONE?u=klnb_fhsuniv&sid=AONE&xid=502147b6
Thanks for sharing
Loretta Gayle Bergman
We still have OB – we deliver a lot of babies. Something goes south the babies to children’s mercy. We have kept babies here that require bubble cpap or oxygen etc. We live in an Amish community. We receive a lot of sick babies and sick mothers in our ER. They tend to wait to present to the ED or OB ward.
We have an ICU. We do not always have an ICU RN on staff – So ER becomes ICU RN in holding for hours or shifts. We life flight patients. Everything depends on the situation what happens and the weather. Our local EMS is having a staffing crisis and that has not helped us out at all. We have had several patients who weigh over 600 lbs and we have trouble finding transport. We use APS a lot out of KC.
Yikes, several over 600 lbs. is hard work. In nursing we have many that are in the 300 lb. range and just a few that are over that. In OB tracing these babies on the fetal monitors is very tough to do. Do you happen to know if you get a septic OB mom, would you ship or keep and if they baby is septic do you ship of keep?
Its great that you keep OB unit open. So many rural areas are having trouble keeping their hospitals open and of the ones that are open they do not keep their OB units going. Have you seen any maternal deaths due to lack of services?
Thanks,
Gayle
It is so great to see the way sepsis protocol has changed over the years, and the decrease in mortality rate due to the changes. Improved patient outcomes is always a priority, and to see the EBP put in to place and to make such a difference is a great thing to witness. Septicemia can be such a terrifying diagnosis, but with early interventions and a good care team it seems less daunting. Kim and Park discuss,’the early administration of antibiotics and intravenous fluids is considered crucial for the treatment of sepsis. In 2016, new sepsis definitions (Sepsis-3) were issued, in which organ failure was emphasized and use of the terms “systemic inflammatory response syndrome” and “severe sepsis” was discouraged (Kim, 2018).’
Kim, Hawn II, MD, & Park, Sunghoon, MD, PhD. (2018) Sepsis: Early Recognition and Optimized Treatment. Tuberculosis & Respiratory disease, 82 (1) 6-14. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6304323/
Yes – it has changed a lot.It’s been for the best for patients.
Yikes, several over 600 lbs. is hard work. In nursing we have many that are in the 300 lb. range and just a few that are over that. In OB tracing these babies on the fetal monitors is very tough to do. Do you happen to know if you get a septic OB mom, would you ship or keep and if they baby is septic do you ship of keep?
Its great that you keep OB unit open. So many rural areas are having trouble keeping their hospitals open and of the ones that are open they do not keep their OB units going. Have you seen any maternal deaths due to lack of services?
Thanks,
Gayle
As nurses we all know that Sepsis is extremely dangerous and if not treated immediately it can damage the organs in a person’s body and lead to death. In Georgia, most hospitals have implemented the three-hour septic bundle. Although I am not an ER nurse, reading your article will help me to function and prioritize care if my patients become septic. Septic shock occurs in both young and old, but I believe older patients are more prone to sepsis. At my facility, Urinary Tract Infections are the main cause for the elderly to become septic and the facility protocol is to transfer patients out to hospitals to be treated. Many of our patients survive and returned to the facility to complete their treatments, but unfortunately, we lost a few. I also found an article, Challenging the One-hour Sepsis Bundle. Interestingly the report shows, “bundles should begin within one hour of physician suspicion of infection-causing hypotension or lactate greater than 4mmol/L.” The report continues to say, “The one-hour bundle challenges providers to send nearly every SIRS-positive patient through a rapid sepsis screening process, which is not feasible or compatible within the daily operations of the ED.” I did not notice a big difference with the intervention when comparing the three-hour septic bundle to the one-hour septic bundle except for the timing. This is a good educational topic to share with my colleagues. I know emergency room nurses are very busy saving lives. I found your paper to be very informative.
References:
Kalantari, Rezaie, & Salim. (2019, January 1). Challenging the One-Hour Sepsis Bundle. Retrieved from https://escholarship.org/uc/item/72w8j3fh
This is great information for me and I’ll share it on my unit. Our hospital has the computerized notices that fire when a patient’s vitals and labs trigger an alert. The nurses then immediately call the doctor, but since the program started it has seemed that most of the alerts are due to errors from the vitals that get automatically sent to the EHR. When the patient was ambulating just prior to vitals or even once when an aid didn’t realize a patient had just been eating ice cream. We still contact the doctor each time but explain that the factors involved aren’t quite right. It has happened so often that I’ve had doctors apologize to me for what they consider a “stupid program”. I’m afraid we’ll start dismissing the alerts all together and miss something important. We often get patients the day their foley is pulled after a surgery and UTIs are common. I don’t feel like my understanding is adequate. I’ll take this information back to my unit and see if we can have more training. We had an online training for sepsis last year but I’m sure I’ve forgotten most of it. Thank you for sharing this.