Early Recognition of Sepsis
Sepsis is among the top ten leading causes of death in the world. It is a serious life-threatening condition and also one of the most expensive diseases to manage. The condition occurs due to a lack of awareness among health practitioners and also due to untimely diagnosis and delayed treatment. Sepsis is also known as septicemia or blood poisoning and they are basically an infection to the bloodstream caused by bacteria, fungi, or a virus. The infection stems from other medical conditions such as urinary tract infections, tooth, liver skin, or infection to any body part. When the signs and symptoms of sepsis are not recognized on time, the internal organs like lungs and kidneys start deteriorating leading to total failure and sepsis develops into severe sepsis. When multiple organs fail, they affect the cardio-circulatory system which leads to a sudden drop in blood pressure causing a septic shock. Despite numerous campaigns and evidence-based treatments, the mortality rate due to sepsis still remains high.
According to American nurse today 30% – 40% of patients die from sepsis annually in America. It also costs the nation almost 20 million dollars annually in healthcare resources because patients suffering from severe sepsis often require prolonged stays in ICUS and a number of supportive therapies like mechanical ventilation and renal support. Early and accurate diagnosis of sepsis is the most critical step in dealing with this deadly and expensive condition or else the deaths due to sepsis will continue to rise. The main purpose of this study is to discuss the role of nurses in early sepsis recognition how the nurses can provide prompt and right clinical practice to reduce the high mortality rate.
The data in this literature review was researched on journals from google and electronic databases. The journals are all recent, having been published in the last five years. The articles used include Role of Nurses in Early Recognition of Sepsis, American Nurse Today.com, Implications of the international Sepsis guidelines for nursing care. In order to get accurate results, only a set of the keyword was used which is “early recognition of sepsis” which yielded a total of 12 articles. The abstract of the first five articles was reviewed to determine whether they were suitable and detailed enough for this literature review and whether they were from a published nursing journal.
Initial Diagnosis of Sepsis
The major cause for the high mortality rate of Sepsis is due to difficulty in diagnosis because it has a wide range of signs and symptoms. Most patients first visit the triage nurses’ who assess the patient and determine the urgency of treatment based on the signs and symptoms that the patient exhibits. Sepsis requires an emergency assessment to better the chances of survival of the patient. The nurses carry out an ABCDE (aspiration, breathing, circulatory, disability, and exposure) system assessment (Sushma, 2016). The Airway system is carried out only when the patient is not conscious since septic shock causes the loss of the airway. The Breathing assessment is carried out to determine the respiratory rate by inspecting, auscultating, palpitating, and percussing. If a patient has a high respiratory rate, then he has it means that he is in hypoxemia and is immediately administered with oxygen. The circulation system analyses the heart rhythm and adequacy of blood circulation by measuring the blood pressure. Skin color is also assessed because it tells how the blood is circulating e.g. a patient with mottled skin means an impending circulatory collapse. Disability analysis means looking out for signs such as agitation, confusion, and low consciousness levels which are caused by decreased cerebral perfusion. Another critical step of the assessment is to find out whether a patient has any obvious infection or suspected infection. This is done by observing any indwelling devices in the patient’s body or any inflammations. Once an infection is discovered, antibiotics should be administered immediately.
When the patient stabilizes, he is moved from the emergency room to a bed in critical care. The triages nurse works together with the ED nurses who ensure a smooth transition of the patient from one nurse to another. The ED nurses also coordinates thorough care for sepsis patients through effective communication with the patient, physicians, support staff and family members. For severe sepsis, nurses communicate findings for the disease through the SBAR (Situation, Background, Assessment and Recommendations) technique. Through this technique, the nurse describes the situation to the doctor or staff explaining what the patient is ailing from. The nurse then describes the background of the patient in terms of his age, name, medical history, time of admission (Dellinger et al., 2013) . She also gives the assessment report such as the pulse rate, temperatures, and blood pressure. Finally, she gives the recommendation for instance requesting for medicine or equipment. Such communication ensures prompt administration of drugs because delays may lead to aggravation of the disease and even death.
Sometimes, when a patient is at the severe sepsis level, intervention bundles are administered to them. The bundles contain a set of elements which are stronger and have greater effect than when individual elements are administered alone. The set of elements occurs in two sets of bundles. The first one is the three-hour bundle which measures the patients lactate levels, gets the blood cultures before administering any antibiotics, administers broad spectrum antibiotics and also administers crystalloids for hypotension. The second level is the 6-hour bundle where vasopressors are administered when hypotension does not respond to initial fluid resuscitation. If hypertension persists, the patient’s tissue perfusions are reassessed. Again, critical care unit nurses should communicate with ED nurses to ensure a smooth transition. In case the ED nurses had no administered a sepsis bundle, it is done in the CCU and if It had been administered and for instance hypotension fails to respond to initial fluid resuscitation, he is able to follow the 6-hour bundle requirement
Role of Nurses
In order to effectively and efficiently identify, manage and improve the quality of care for septic patients, nurses need to work as a team. There are clinical educators who serve as mentors and teachers to both the new and experienced nurses. They educate them on new procedures and protocols and also on how to improve their performance. They also help nurses learn how to communicate severe sepsis results to physicians. There are also nursing informatics specialists who help to align the nurses with modern technology. They develop programs for progressive sign surveillance and alerts and also come up with hospital education programs. Automated prompts can enable the nurses to automatically detect vital signs and laboratory data which enables the nurse to assess the patient for sepsis. There are clinical documentation specialists who know various diagnoses and are good at interpreting the EHR. The sepsis response team on the other hand is committed to providing early sepsis interventions. The team also includes a critical care nurse and/ They are good at diagnosing and managing severe sepsis and together they administer antibiotics, fluids, and even respiratory support. They also liaise between nurses and physicians to report their findings, to place orders, and in some cases, they recommend that a patient be transferred to a higher level of care (Kleinpell, Aitken & Schorr, 2013). There is also a sepsis coordinator who is in charge of a multi-disciplinary team that provides care to the sepsis patients. The coordinator develops educational programs, puts measures that ensure adherence to the sepsis program, and in some instances, he ensures that health providers are following the best practices for sepsis care. Finally, there is the researcher who finds methods for implementing sepsis programs locally. Such research encourages innovations and testing for instance better ways of sepsis identification and better methods of managing it.
Early recognition of sepsis has proved to be effective in reducing the mortality rate. Researchers have found out that patients who are diagnosed with sepsis has increased by 20% and mortality rate due to sepsis has declined from 30% to 25.4%. Additionally, the percentage of adults who received prompt treatment increased from 41.55% TO 55.2% while that of children has increased from 4.9% to 17.6% (Vogel. 2017). This is also attributed to the nurses role of early sepsis treatment, and proper communication using the SBAR tool, the administration of the sepsis bundle and also working as a team.
Sepsis, severe sepsis and septic shock are still the leading cause of deaths globally. They are also a huge economic burden to several countries. Fortunately, accurate and timely screening, timely communication and prompt treatment can effectively reduce the number of deaths. This will however require nurses to work together so as to deliver an optimal level of sepsis care.
Dellinger, R., Levy, M., Rhodes, A., Annane, D., Gerlach, H., & Opal, S. et al. (2013). Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock, 2012. Intensive Care Medicine, 39(2). doi: 10.1007/s00134-012-2769-8
Kleinpell, R., Aitken, L., & Schorr, C. (2013). Implications of the New International Sepsis Guidelines for Nursing Care. American Journal Of Critical Care, 22(3), 212-222. doi: 10.4037/ajcc2013158
Sushma, S. (2016). IDENTIFYING AND ASSESSING PATIENT’S SEPSIS BY NURSES IN AN EMERGENCY DEPARTMENT: A Literature Review (undergraduate). CENTRIA UNIVERSITY OF APPLIED SCIENCES.
Vogel, L. (2017). England, US report sepsis successes. Canadian Medical Association Journal, 189(43), E1348-E1349. doi: 10.1503/cmaj.109-5509