Nursing Study on Sepsis
It refers to a complication of infection and occurs when the antibodies in the bloodstream trigger inflammation in the entire body. The resultant inflammation can lead to a cascade of changes that destroy various organs and systems thus their failure (De Backer & Dorman, 2017). This article dwells on sepsis, its detection, and treatment. It focuses on the management concerning the comparison between the use of the SIRS criteria and the usual supportive management.
Healthcare Problem
In comparison to other diseases, sepsis is considered to be one of the conditions that lead to high disability and mortality cases. Over the recent years, the incidence of the condition has risen, and this can be related to factors such as advanced ages, infection by multiresistant organisms as well as immunosuppression among many patients. In the case of occurrence, sepsis can lead to complications such as the death of various systems and vital organs.
Significance of Problem
According to De Backer & Dorman, (2017) sepsis is considered to be life-threatening and affects a good number of Americans, approximately one million per year. Its life threatening nature is related to the fact that it affects the vital organs and can lead to failure of multiple systems. The infection may be contracted through the respiratory system, skin, puncture intravenous lines among others and can be from any microorganisms, i.e., viruses, bacteria or fungi. Kliger, Singer & Hoffman, (2015) recognizes that in the event the infection gets into the bloodstream, it gets spread to various body parts and can lead to damage to multiple vital organs.
Current Practice
There exists no known cure for sepsis as a condition and management remain supportive care to the individual. It is, therefore, crucial to provide support to various systems and organs while the body defends itself. The recommended treatment is fluid therapy at the initial moments of the condition to boost blood pressure and supply to essential organs. Oxygen therapy is also used to allow oxygenation of various organs hence preventing their death. Other intervention processes include the use of vasopressors to maintain blood pressure, nutritional maintenance to nourish the body tissues as well as dialysis to eliminate excess toxins related to sepsis.
Impact on Background
Sepsis has impacted health management in a significant way concerning disease management as well as financial constraints to various institutions. The cost of handling the condition has risen based on the increased incidences of the condition in various emergency departments. The financial implications are even raised further due to the need for care to complications from the diseases as well as the increased incidences of readmission as well as the use of numerous resources especially when it involves admission into the intensive care unit. Hospital-related causes of infection, as well as the high number of re-admissions pertaining sepsis occurrence, reduce the ratings for individual institutions and care centers.
PICO Table
| P (patient/problem) | The development of sepsis in hospitalized patients. |
| I (intervention/indicator) | Use of SIRS criteria and goal directed therapy in managing sepsis. |
| C (comparison) | Normal acre encompassing supportive management with fluids and use of antibiotics. |
| O (Outcome) | Reduced incidences of sepsis related mortalities. |
PICO Question
Among the hospitalized patients, will use of SIRS criteria and goal-directed therapy compared to the usual sepsis management with fluid therapy and antibiotic use result in reduced sepsis-related mortalities?
Keywords/Number and types of articles
The keywords used for search encompassed sepsis that resulted in 532,738 articles and severe sepsis which resulted in 331,762 articles. The themes of various articles entail the development of the condition, education to create awareness and early detection. Various guidelines for treatment of sepsis from 4,318 articles focused on the use of fluid therapy to manage the condition. Another critical issue that emerged was the involvement of the leadership of various care centers in preventing sepsis as well as proper management of the condition upon diagnosis. This aspect was covered in 26,385 articles that revolved around nurse leadership in sepsis.
Research Articles
One of the research articles by Tusgul et al., (2017) on the low sensitivity of qSOFA, SIRS criteria and sepsis definition in the identification of infected patients at risk of complication in the prehospital settings and various emergency department s triage determined the suboptimal state of the three tools. In their research, a retrospective study was done on 886 patients who were either suspected or proven to be infected. With the study determining the incidence of sepsis in the emergency department among patients transported by ambulance to be 3.8%, the mortality was high. This high rate necessitated the need to dispose of a test that would allow early identification of such patients. By determining the suboptimal status of the three tools on the sensitivity performance, they turned to be of low identification sensitivity in determining patients that are at risk of complications.
The second research study dwelt on the use of fluid therapy and antibiotics in the management of sepsis (Hayden et al., 2016). It aimed at evaluating the efficacy of early and prompt identification of sepsis in the emergency department then application of the sepsis workup and treatment (SWAT) protocol. A quasi-experimental study was done on 238 patients who were all above 18 years old. The study determined a significant reduction in the time to antibiotics and time to intravenous fluids for patients with sepsis based on the protocol.
Non-research Articles
One of the non-research articles “Surviving Sepsis Guidelines” was launched with a seven-point agenda to start awareness on the importance of sepsis, improving the diagnosis and recognition, defining and using of appropriate treatment, educating the healthcare professionals, enhancing the post-intensive care unit interventions, coming up with the guideline of care as well as implementing the proper guidelines to improve the set program. Their goal was to have standardized guidelines put in place so patients will receive appropriate treatment (De Backer & Dorman, 2017). An observational study was done after the intervention revealed a marked reduction in mortality that was associated with the seven-point agenda.
The second non-research article was about Surviving Sepsis Campaign. The study sampled the various interventions that are vital in the management of sepsis. These interventions encompass of monitoring the levels of serum lactate and fluid resuscitation (Wang, 2017). This management is then followed by culturing of sputum, urine, and blood before antibiotics are administered. At the same time, the antibiotic ought to be given within one hour of diagnosis to thwart the spread of the condition. Vasopressors and fluid resuscitation are used to maintain the blood pressure and enhance blood supply to various organs. The study also determines the significance of oxygen therapy which can be achieved via the use of mechanical ventilation to support the respiratory system.
Evidence Matrix
| Authors | Journal Name/ WGU Library | Year of Publication | Research Design | Sample Size | Outcome Variables Measured | Level (I–III) | Quality (A, B, C) | Results/Author’s Suggested Conclusions |
| Mouncey, P. R., Osborn, T. M., Power, G. S., Harrison, D. A., Sadique, M. Z., Grieve, R. D., … & Coats, T. J | . New England Journal of Medicine | 2015 | A randomized trial study | 1260 patients | Risk reduction, health related quality of life and rates of serious adverse effects. | I | A | By 90 days of the study, 29.5% in the emergency goal directed therapy group and 29.2 in the usual care group had died. No other significant difference in other outcomes was also noted. This led to the conclusion that the use of emergency directed goal therapy protocol had no improvement in the outcome of patients with sepsis. |
| ProCESS Investigators | . New England Journal of Medicine | 2014 | Randomized control trial | 1341 patients | Risk reduction, occurrence of adverse cases and health related quality of life. | I | A | In the study, there were 21.0% deaths for the EMDT group and 18.9% for the usual care. the authors concluded that the protocol based resuscitation of patients with septic shock did not have any improved outcomes. |
| Hayden, G. E., Tuuri, R. E., Scott, R., Losek, J. D., Blackshaw, A. M., Schoenling, A. J., … & Hall, G. A. | The American journal of emergency medicine | 2016 | Retrospective, quasi-experimental study. | 238 patients. | Vital signs of patients, serum lactate levels, mortality from sepsis | II | A | 238 patient charts were obtained ith groups of pre-SWAT and post-SWAT. No differences were determined in triage SIRS criteria compared to the pre-SWAT group. The shock index was high with post-SWAT group. The study determined that it was essential for early detection of shock and utilization of evidenced based therapies such as the use of fluid therapy. |
| Tusgul, S., Carron, P. N., Yersin, B., Calandra, T., & Dami, | Scandinavian journal of trauma, resuscitation and emergency medicine | 2017 | Retrospective study | 886 patients | Sensitivity of qSOFA, sensitivity of SIRS criteria, mortality rate from sepsis. | II | A | The sensitivity of qSOFA was 36.3% for ICU admission and 17.4% for ICU stay. Sensitivity of SIRS criteria was 68.8% for ICU admission and 74.6% for ICU stay. With the incidence rate of sepsis during transfer of patients to the emergency department at 3.8%, the authors determined the need for adoption of methods that are able to detect the condition early enough to prevent mortality. |
| Angus, D. C., Barnato, A. E., Bell, D., Bellomo, R., Chong, C. R., Coats, T. J., & Howe, B | Intensive care medicine | 2015 | Quantitative study- systematic review of randomized clinical trials | 4735 patients | Mortality outcome, impact of early goal directed therapy. | II | B | The study determined no significant impact on the primary mortality outcome with the use of early goal-directed therapy. The authors concluded that despite the fact the therapy is not better than other usual care strategies for septic sepsis; it was associated to effective use of care resources. |
Practice Change
As depicted by De Backer & Dorman, (2017), sepsis forms one of the life-threatening conditions that lead to a significant number of mortalities. To avert this satiation, there is need to carry out further studies to better the management of patients with sepsis that goes beyond the emergency goal directed therapy. This move can be related to the determination by the studies conducted by Mounceyet al,. (2015) and ProCESS investigators (2014) of no significance in the use of the emergency goal directed therapy over the usually conservative care.
Similarly, there is need to diversify various practices within the usually conservative management to enhance the patient outcome in managing sepsis. As illustrated by Hariyanto et al., (2017), laboratory workups and fluid therapy need to be initiated promptly. The fluid is administered at the ration of 30ml/kg. The one hour window period is vital for the administration of the antibiotics though this should be preceded by blood, urine and sputum cultures. The state of sepsis is monitored via measurement of lactic acid before and after the administration of intravenous fluids. Tusgul (2017) argues that there is a significant need for early diagnosis and prompt management in the management of sepsis as well as prevention of morbidities and mortalities associated with the condition.
Involving key stakeholders
The top leadership within the nursing team forms the topmost stakeholder to involve in the implementation process. This involvement is based on the fact that they manage the funding for the supplies and equipment which are vital in managing sepsis. At the same time, they influence policies and guidelines in nursing practice. The second team of stakeholders is the nurses who are at the forefront in caring for the patient. By involving them, the desired change is implemented to impact the lives of the patients. The physicians are also vital team players as they are key in the diagnosis and making orders related to managing the patients. There practice and knowledge ought to be up to date with the current guideline for the proper management of the condition.
Barriers to practice change
Staff resistance to change is one of the anticipated challenges in the implementation of the practice change. This hindrance can be related to the consideration of the idea to be an external issue this need not to be embraced. Others may also find it hard to come off the initial practices. Based on the quick spread of sepsis to shock and need for prompt determination and management, time is likely to be a challenge in the process of achieving guideline laid processes.
Overcoming the Barriers
Through education, the staff can get equipped with the knowledge and skills to determine and manage sepsis. In so doing, the nurse will feel to be included in the planning phase of the change thus embrace it by considering it to be an internal idea. At the same time, having a special team responsible for surveillance and monitoring of patients sepsis score can be crucial in the determination of the condition.
The impact of the intervention can be determined by monitoring of the desired changes. A team can be selected to monitor a unit, for instance, the emergency department and then trend the number of septic patients and even determine the mortality rates. The trends can then be determined from information recorded over a period.
Conclusion
Sepsis is a critical clinical problem and all healthcare providers ought to take note of prevention, early detection and prompt treatment to avert the increased mortality rates. As determined by various studies, there is need to employ more goal-oriented care that would yield better outcomes for patients on top of the usual supportive care. In so doing, the functions of various organs can be preserved, and patiently assisted in the recovery. In implementing, the use of goal-oriented therapy, there is the need to involve various stakeholders to give room for smooth adoption.
References
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Hayden, G. E., Tuuri, R. E., Scott, R., Losek, J. D., Blackshaw, A. M., Schoenling, A. J., … &
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Kliger, J., Singer, S. J., & Hoffman, F. H. (2015). Using the integrated nurse leadership program
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Mouncey, P. R., Osborn, T. M., Power, G. S., Harrison, D. A., Sadique, M. Z., Grieve, R. D.,
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ProCESS Investigators. (2014). A randomized trial of protocol-based care for early septic
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Tusgul, S., Carron, P. N., Yersin, B., Calandra, T., & Dami, F. (2017). Low sensitivity of
qSOFA, SIRS criteria and sepsis definition to identify infected patients at risk of
complication in the prehospital setting and at the emergency department
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