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Recommended: Sepsis case study icu
Sepsis has gained much focus as a major global health problem. Since 2003, an international team of experts came together to form the Surviving Sepsis Campaign (SSC), in the attempts to combat an effectively treat sepsis. Although, diagnostics and protocols have been developed to identify high risk patients, the need for human clinical assessment is still necessary to ensure a proper diagnosis is made and appropriate treatment is initiated in a timely manner. The use of a highly efficient and experienced team, such as, the electronic Intensive Care unit (eICU) could close the gap from diagnosis to treatment.
Clinical Practice Question
Will implementing sepsis screening by the eICU for ICU and Step-down units improve earlier diagnosis and treatment of sepsis compared to waiting for admitting physician to assess the patient?
Critical Appraisal Components
1st Critical Appraisal Component in CETEP Model Evidence-Based Factors:
Research
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Sepsis was associated with high mortality rates due to delay in diagnosis and treatment. The study was performed over 3 years in an ICU setting, screening over 68,000 patients, which, identified 5437 cases of severe sepsis (Badawi & Hassan, 2015). The article further discusses how tele- ICU’s can support and improve patient outcomes by screening for systemic inflammatory response syndrome (SIRS), prior to a patient developing severe sepsis. Moreover, screening is considered a vital component to improve survival rates in sepsis; screening gives promise to patients of early intervention and improved outcomes (Badawi & Hassan,
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.
It starts as sepsis then progresses to severe sepsis and then septic shock. In the United States alone there are 751,000 cases of severe sepsis a year with a hospital mortality rate of 28.6% or 215,000 deaths a year. For comparison there are 180,000 deaths a year from heart attacks and 200,000 deaths a year from lung or breast cancer (Nguyen et al). When compared to the numbers for diseases that are talked about every day, it is staggering the impact that sepsis has. Not only is it a lethal disease but it is costly as well. Sepsis took up $16.7 billion in national hospital costs (Nguyen et
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
Considering the conflicting findings amongst the different EWS, it remains unknown whether these scoring systems are effective in identifying and responding to deteriorating patient in acute hospital settings. This essay intends to establish how successful, if at all, the EWS in particular SHEWS is in identifying deteriorating patients in acute surgical hospital settings. In order to do this we will be returning to patient X, a 22-year-old Asian female with a diagnosis of acute pancreatitis. By comparing the evidence base to reality I hope to get a better understanding of how effective this tool is in identifying deteriorating patients.
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 shows that when healthcare facilities, care teams, and individual doctors and nurses are aware of infection problems, and take specific steps to prevent them, rates of some targeted HAIs can decrease by more than 70%. Participation in an ongoing system, established for monitoring and consumer reporting of health outcome data, [has resulted in] reduced rates of HAI, improved hospital outcomes, and reduced mortality, overtime. [For example / Studies have reported that,] compared to states with no reporting requirement, those units in states with voluntary reporting systems or with longer periods of mandatory reporting experience had higher infection rates at baseline and/[but] greater reductions in HAIs within six months. [That said / Still,] the challenge remains [however,] that [state legislation / current practices] varies widely regarding which HAIs to measure and report, how the data are collected and analyzed, and the public availability of disclosed
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.
Urden, L. D., K. M. Stacy, and M. E. Lough. Critical care nursing, diagnosis and management. Mosby Inc, 2010. eBook.
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...
E. Coli 0157, written by Mary Heersink, is a nerve-racking, adrenaline-filled story of a mother's experience with a then unknown deadly bacteria. The book brings up many reactions in its readers, especially the questioning of the practice of doctors in hospitals. The reader's knowledge base of scientific procedures in emergency centers was widened as well as the knowledge of how to the human body reacts to different agents in its system.
CLABSIs are not confined to one unit of nursing care and there are many precipitating factors that may contribute to the development of a CLABSI. Often times these lines are placed in emergent situations in the emergency department (ED) and there may be a break in sterile technique. However a study conducted by Smith, Egger, Franklin, Harbrecht, and Richardson (2011) found a higher incidence of CLABSIs among intensive care unit (ICU) patients compared to those patients whose CLs were placed either in the ED or operating room (OR). This indicates further education for ICU s...
Sayar S.,Turgut, S., Dogan, H., Ekici, A., Yurtsever, S., Dermirkan, F., Doruk, N., Tsdelen, B. (2009) Incidence of pressure ulcers in intensive care unit patients at risk according to the Waterlow scale and factors influencing the development of pressure ulcers. Journal of Clinical Nursing 18, 765-774.
Managing critically ill patient is very sensitive to the time factor. This emphasizes the importance of using Point-Of-Care Testing (POCT) in emergency rooms, operation rooms and intensive or critical care unites. On the other hand how we can guarantee the validity of Point-Of-Care Testing and its correlation with the laboratory results. This paper emphasizes on, both the importance and validation of Point-Of-Care Testing results for the critically ill patients.
This paper’s brief intent is to identify the policies and procedures currently being developed at Midwest Hospital. It identifies how the company’s Management Committee was formed and how they problem solved and delegated responsibilities. This paper recognizes the hospital’s greatest attributes and their weakest link. Midwest Hospital hired Dr. Herb Davis to help facilitate the development and implementation of resolutions for each issue.
Sepsis is a critical condition caused by an overreacting immune response to an infection. Most of the time, such infection are caused by bacteria. When a person is being infected, chemicals are released into the bloodstream to fight off infection. This may result in multiples inflammation found within the body. Inflammation can trigger a cascade of event which may cause multiple organ damage, leading to multiple failure of organs where the body is unable to function normally. In worst scenario, infection can lead to an increase in low blood pressure which rapidly leads to the failure of several organs causing death. Besides causing inflammation, it also causes increased in coagulation, decreased fibrinolysis and decreases the amount of activated protein C in the body (Tazbir, 2004).