Sepsis is a common cause of organ failure and transfers to higher levels of care in medical-surgical patients. Medical-surgical nurses often lack the education to see the beginning stages of sepsis. The study I found in a medical surgical journal looked at the sepsis reporting rates on a 58 bed medical floor. The study was conducted by providing a pre test to see what the nurses on the medical floor’s knowledge base is. As well as, an interactive training and a post test two months after the interactive training. The study also looked at the use of a sepsis screening tool in the charting system to flag the patients at high risk so the nurse will notify the provider. The goal of this study is for the nurse to understand the signs and symptoms of sepsis and report them to the provider early to ensure a better outcome for the patient.
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Sepsis is a big deal in the Nursing world. Unfortunately, patients are not being tested on time for sepsis and some are misdiagnosed for something completely different. At my job, we have to test patients for sepsis if they come to the hospital with fever and other cold symptoms. It is better safe than sorry.
Sepsis assessments are something my place of employment added to our intervention list for charting about five years ago. We have to chart on all inpatients a sepsis assessment every shift and/or with any change in condition. If the patient flags for a sepsis alert the assessment will tell you to call a sepsis alert. Alerts bring in a doctor, phlebotomy, radiology, respiratory therapist and fellow nurses. After an alert an order set is set in place if indicated to repeat lactate levels every six hours and procalcitonin levels every 48 hours.
Sepsis is a life-threatening emergency and in 2017 an estimated 48.9 million cases of sepsis were documented worldwide (Rudd et. al, 2019). Having a safety bundle readily available is helpful to ensure that everything is done timely and correctly. There have been many different types of “bundles” adopted by emergency departments throughout the world with the same goal of giving the patient the best possible outcome. Compliance with the bundles and protocols seem to be a problem everywhere. Right now, during the Covid-19, the argument could be made in some cases that there is not enough staff to complete everything on time. Another possibility could be that staff were just told to do enact these protocols and bundles but do not fully understand the importance of it. Perhaps more education is needed?
Frankling, C., Patel, J., Sharif, B., Melody, T., Yeung, J., Gao, F., & Szakmany, T. (2019). A Snapshot of Compliance with the Sepsis Six Care Bundle in Two Acute Hospitals in the West Midlands, UK. Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine, 23(7), 310–315. https://doi.org/10.5005/jp-journals-10071-23204
Rudd, K. E., Johnson, S. C., Agesa, K. M., Shackelford, K. A., Tsoi, D., Kievlan, D. R., Colombara, D. V., Ikuta, K. S., Kissoon, N., Finfer, S., Fleischmann-Struzek, C., Machado, F. R., Reinhart, K. K., Rowan, K., Seymour, C. W., Watson, R. S., West, T. E., Marinho, F., Hay, S. I., Lozano, R., … Naghavi, M. (2020). Global, regional, and national sepsis incidence and mortality, 1990-2017: analysis for the Global Burden of Disease Study. Lancet (London, England), 395(10219), 200–211. https://doi.org/10.1016/S0140-6736(19)32989-7
Allie, great up to date article on Sepsis. I have been working in the field as a Paramedic for the past 6 years and always have in my mind “Sepsis” for medical related sick calls. I will call a “Sepsis Alert” over the radio during patient care report to the appropriate destination prior to arrival if the patient meets the Sepsis Alert protocol for the agency I currently work for. This protocol states to “consider a sepsis alert if” I have two of the following: Elevated body temp greater than 100.4 F, Tachycardia, etco2 of 25 or less, and decreased LOC. Recognizing Sepsis early in the field and calling a Sepsis Alert to the arrival destination will increase the chances of the patient meeting Sepsis treatment in under 60 minutes. A lot of times I have seen patients who do not meet this criteria and are still septic depending on the stages of sepsis they are in. Currently in the ER I work in as a nurse I fill out a Sepsis Worksheet on the patients that meet certain criteria. It is up to me as the nurse to identify if the patient meets the Sepsis Worksheet need. If I wait for the physician to tell me to do a Sepsis work up than the chances are, the physician is usually saying this to me in passing right around the 60 minute mark, a little too late. As a nurse I am helping the physician identify the sepsis work up need and start the ball rolling in the right direction to increase the patients outcome and survival from sepsis. In the study you researched I noticed physicians often do not recognize sepsis in a timely manner. The administration of a sepsis bundle has 5 key factors that can improve the patients outcome if met in a timely manner of 1 hour. 1. Measure lactate level, and remeasure if lactate is greater than 2. Obtain blood cultures prior to administration of antibiotics. 3. Administer broad spectrum antibiotics. 4. Begin rapid administration of 30ml/kg crystalloid for hypotension or lactate greater than or equal to 4. 5. Apply vasopressors if pt is hypotensive after or during fluid resuscitation and keep MAP greater than or equal to 65. (Kim & Park 2019)
Reference
Kim, H. I., & Park, S. (2019, January). Sepsis: Early Recognition and Optimized Treatment. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6304323/
I found this to be a very pertinent article with a good study design. Sepsis is something that will always be a high priority issue in the field of nursing and early recognition is key. I would be very curious to see how this study could be implemented in the emergency department, and how nurses and/or physicians could also be prompted to recognize early sepsis with prompts in an EHR? I agree with the authors discussion that sepsis education must be ongoing for hospital staff as their data showed knowledge to decline over time (Burog, Carrion, Luna, Silverstr-Elmore, & Turner, 2020).
Burog, R., Carrion, J., Luna, N., Silverstr-Elmore, A., & Turner, B.S. (2020). A Quality Improvement Project to Evaluate the Implementation of a Sepsis Education Program in a Medical-Surgical Department. MEDSURG Nursing, 29(1), 34–62.
Sepsis begins outside of the hospital for nearly 80% of patients (Jimenez, 2017) This statistic is crazy! This article points out some other facts that you may find useful including somethings from the CDC. Sepsis is something that happens so fast as a nurse that sometimes we often don’t know how to identify it. It makes me wonder if your study had been done in another setting other than just the medical field what kind of results they would get also?
Jimenez, S. J. S. (2017, September 12). Nurses have tools to help prevent sepsis. Retrieved from https://www.nurse.com/blog/2017/09/12/nurses-have-tools-to-prevent-sepsis/