Sepsis is defined as a systemic inflammatory response caused by an infective process such as viral, bacterial or fungal (Holling, 2011). Assessment on a patient and starting treatment for sepsis is based on identifying several factors including the infective source, antibiotic administration and fluid replacement (Bailey, 2013). Because time is critical any delay in identifying patients with sepsis will have a negatively affect the patients’ outcome. Many studies have concluded every hour in delay of treatment mortality is increased by 7% (Bailey, 2013). Within this assignment I will briefly discuss the previous practice and the recent practice including the study based on sepsis. I will show what enabled practice to change and I will use the two comparisons of current practice and best practice.
Sepsis is a life threating health condition and if not treated early can lead to shock, multiple organ failure and death (Ho, 2012). The main study of which practice has been based world-wide is the Surviving Sepsis Campaign. The Surviving Sepsis Campaign was developed to create evidence-based management guidelines. The Surviving Sepsis Campaign completed this by using an educational program to implement the guidelines by integrating their recommendations into resuscitation and management bundles (Marik, 2011). The first Surviving Sepsis Campaign Guidelines were published in Critical Care Medicine in 2004 with an updated version published in 2008 with the core of the recommendation's remained largely unchanged (Ahrens, 2011).
Within the Surviving Sepsis Campaign they introduced guidelines and bundles which may beused as the basis of a sepsis performance improvement program. The Guidelines were based around a six-point action plan (...
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...0% realize it is a leading cause of death (World Sepsis Day, 2012). If sepsis can be diagnosed early and managed appropriately, lives can be saved. A key factor in the lack of public awareness of sepsis relates to the fact that there is still a lot of confusion of what sepsis really is. Diabetes, cancer, and arthritis are very clear conditions that everyone recognizes, but sepsis can be a vague term, suggestive of a blood infection (World Sepsis Day, 2012).
In conclusion researching and updating current studies are a major influence in creating new evidence based guidelines in treating sepsis. Continuing to study sepsis and reviewing newer guidelines will provide safer care for patients. The path toward reducing sepsis mortality begins with early recognition from both nursing and medical staff and also giving education to patients prior to them even presenting.
Also, cytokines are used as they can destroy the infection, however there is a problem with this diagnosis as excessive production can cause tissue and organ damage. The pathological physiological outcomes of sepsis is that there is a multi-organ dysfunction that includes the heart, brain, kidneys and the lungs. Acute respiratory distress syndrome (ARDS) is a condition where there is a low oxygen level in the blood, this mostly affects the lungs, people who have sepsis will be affected by ARDS as their breathing rate will decrease. Another reason for multi-organ dysfunction is that there is a lack of blood being given to the organs, this causes low blood pressure or as it’s called hypotension, this mostly affects diabetic people which leads them to having sepsis.
The guidelines’ first focus is the definition of sepsis, which makes sense, because there is no way to effectively treat sepsis without an accurate and categorical definition of the term. The guidelines define sepsis as “the presence (probable or documented) of infection together with systemic manifestations of infection”. Such systemic manifestations can include fever, tachypnea, AMS, WBC >12k, among others; these manifestations are listed in full in Table 1 of the guidelines. The definition for severe sepsis builds on to the definition of sepsis, bringing organ dysfunction and tissue hypoperfusion (oliguria, hypotension, elevated lactate) into the picture; full diagnostic criteria is listed in Table 2. The guidelines recommend that all
Recognition, response and treatment of deteriorating patients are essential elements of improving patient outcomes and reducing unanticipated inpatient hospital deaths (Fuhrmann et al 2009; Mitchell et al 2010) appropriate management of the deteriorating patient is often insufficient when not managed in a timely fashion (Fuhrmann et al 2009; Naeem et al 2005; Goldhill 2001). Detection of these clinical changes, coupled with early accurate intervention may avoid adverse outcomes, including cardiac arrest and deaths (Subbe et al. 2003).
Ventilator-associated pneumonia (VAP) remains to be a common and potentially serious complication of ventilator care often confronted within an intensive care unit (ICU). Ventilated and intubated patients present ICU physicians, nurses, and respiratory therapists with the unique challenge to integrate evidence-informed practices surrounding the delivery of high quality care that will decrease its occurrence and frequency. Mechanical intubation negates effective cough reflexes and hampers mucociliary clearance of secretions, which cause leakage and microaspiration of virulent bacteria into the lungs. VAP is the most frequent cause of nosocomial infections and occurs within 48 hours of intubation. VAP is a major health care burden with its increased morbidity, mortality, longer ventilator days and hospital stay, and escalating health care cost.
Research by Hotchkiss, Monneret, & Payen’s (2013) has revealed that sepsis is an immunosuppressive disorder, therefore patients can benefit from immunostimulatory therapies used to treat those who have lowered immune systems. Accordingly, focusing on boosting the immune system has been shown to decrease mortality in patients (Hotchkiss et al. 2013). Hotchkiss et al. (2013) announces that while these statistics are encouraging, the mortality rate is still considered high and further research and techniques are needed in order to continue the downward trend. Hotchkiss et al. (2013) states that it is unclear why some patients survive sepsis and others do not recover. Until the true cause of death in sepsis is understood, the best course of action is prevention, early detection, and immune system support.
Williams, M. (1998). In C.M. Hudak, B.M. Gallo, and P. Gonce Morton. (Eds.) (1998). Critical Care Nursing. A Holistic Approach. 7th Edition. Philadelphia: Lippincott-Raven Publishers.
Journal of Critical Care, 503.) The leading causes of most errors among stress and interruption are other factors such as: wrong dosage, dose omissi...
In the critical care population, patients on ventilator support require nutritional supplementation. To support the metabolic processes, healthcare providers address the initiation of feedings within the plan of care (Khalid, Doshi, & DiGiovine, 2010). For therapeutic nutritional support, providers compare the risks and benefits of enteral and parenteral feedings. Following intubation, one goal is to initiate feedings within 24 to 48 hours, to provide optimal patient outcomes, and decrease the risk of ventilator-acquired pneumonia (Ridley, Dietet, & Davies, 2011).
The term “failure to rescue” refers to a clinical scenario where hospital doctors, nurses, or caregivers fail to recognize symptoms. Responders do not respond adequately to clinical signs that would prevent harm (Morse, 2008, p.2). Dr. Jeffery H. Silber, Director of the Center for Health Outcomes and Policy Research, first coined the term “failure to rescue” in the 1990’s. He characterized the matrix of institutional and individual errors that contribute to patient deaths as “failure to rescue” (Aleccia, 2008). Since 1990, it has been well documented patients usually exhibit signs and symptoms of impending cardiac or respiratory arrest 6-8 hours before an arrest (Schein, Hazday, Pena, Ruben, & Spring, 1990). Buist, Bernard, Nguyen, Moore, and Anderson’s (2004) research reported similar findings. They found patients had documented clinically abnormal signs and symptom prior to arrest (Buist, et al., 2004). When certain abnormal signs and symptoms are identified early, critical bedside consultat...
Goeschel (2011) described one collaborative cohort study that almost eliminated CLABSIs in over 100 ICUS across the United States, which implemented lessons from a Johns Hopkins collaborative project, called Matching Michigan. The results of this study were so astounding nursing leaders across the globe pushed to match their efforts, but found themselves at a cross-roads when implementing these changes. Some found it difficult to implement change policies due to technical and adaptive challenges. Goeschel stated nurse leaders needed to step forward, in all patient care settings, to bridge the gap between evidenced-based practice and current nursing care. She believed nurses should be at the forefront of change, pushing evidence-based practice standards forward to provide quality and safe patient care practices.
Evidence-based practice integrates best current evidence with clinical expertise and patient/family preferences and values for the delivery of optimal health care (qsen.org). Like most medical professions, nursing is a constantly changing field. With new studies being done and as we learn more about different diseases it is crucial for the nurse to continue to learn even after becoming an RN. Using evidence-based practice methods are a great way for nurses and other medical professionals learn new information and to stay up to date on new ways to practice that can be used to better assess
With patient safety always being the number one priority FTR is the worst case scenario for the hospitalized patient. In an article titled “Failure to Rescue: The Nurse’s Impact” from the Medsurg Nursing Journal author Garvey explains ways FTR can occur “including organizational failure, provider lack of knowledge and failure to realize clinical injury, lack of supervision, and failure to get advice.” Nurses are problem solvers by nature, they heal the sick and help save lives. FTR is a tragic experience for everyone involved. The recent surge in this happening across the country has given FTR cases widespread media coverage. Hospitals are trying to figure out what the root cause is and how they can be prevented. Fortunately, with the advancement of technology and extensive research many hospitals have developed action plans and procedures to help prevent the early warning signs from being
When caring for patients it is fundamentally important to have a good selection of up to date evidence Based Practice clinical articles to support research strategies, this allows professionals to assemble the most resent and accurate information known which enables them to make decisions tailored to the individual’s plan of care. It is essential to have clinical expertise and have the involvement from the individual patient, they must have full engagement and incorporation in order to have the accurate evaluation.
“ Sepsis” according to the International Surviving Sepsis Campaign, is defined as the presence of infection together with systemic manifestations of infection (Dellinger et al., 2013) In todays modern society sepsis still accounts for 15% of maternal deaths a year worldwide (Dolea & Stein, 2003). Despite medical advances, aseptic technique, and antibiotic use, sepsis is the most common cause of direct maternal death in the UK. According to the CMACE report the maternal mortality rate increased from 0.85 deaths per 100,000 maternities in 2003–05 to 1.13 deaths in 2006–08 (Harper, 2011). Puerperal sepsis has a long history within obstetrics and midwifery, and yet despite this knowledge it has become, yet again, the leading cause of direct maternal death. Therefore due to the increased maternal mortality, I have chosen to focus on the care of a woman within ...
QSEN is started as an initiative to give future nurses the quality education necessary to provide the quality care and safety for the community (Potter, Perry, Stockert, Hall, & Ostendorf, 2017). This nursing care ties in with the standard of care in competency because QSEN is providing the level of education needed for future nurses to be competent to provide the appropriate care for patients. Nursing process is break down of the care and treatment a patient is given depending on their illness in 5 stages of assessment, nursing diagnosis, planning, implementation and evaluation. The standard of care that can be defined by this nursing care is available information given. Nurses assess patients based on the chief complaint that patients give. The importance of this correlation is the rapport that is builds between nurse and patient. For example, if a patient does not disclose recreational use of opioids and the nurse gives them a sedative, such as propofol, for a procedure, the patient’s respiratory system will decline immediately. This is an example of lack of information given in which the nurse was not able to give the appropriate care and treatment. Last but not least, is the nursing care established on evidence-based practice. An example of this is the use hand sanitizers before and after enter a patient’s room. This practice has become a policy at many facilities to decrease infection. This correlates with the standard of care of following approved