Purpose: Current evidence based research demonstrates that the utilization of defined sepsis care guidelines, provide time sensitive treatment protocols that help guide nurses through effective early initiatives in reducing patient mortality. Since time of treatment for sepsis is outlined as being most effective if delivered in the first six hours following diagnosis, it is imperative to treat patients as soon as they arrive in the hospital for treatment. Emergency departments (ED) are the most common initial route of care that patients take for hospitalization of sepsis type infections. Currently many hospitals do not have a defined treatment protocol that initiates this needed treatment to start in the ED. Sepsis bundles offer ED nurses the guidelines that are needed to help care for such patients.
Method: A traditional review of 19 peer journal articles of both qualitative and quantitative designs were researched. Each article was reviewed to measure that the purpose, study method, and the conclusion of the study were relative to the purposed need for evidence based change in practice.
Results: All of the articles reviewed gave evidence to the importance of early intervention in the treatment of sepsis to reduce patient mortality. Sepsis bundles in practice offered time sensitive treatment protocols that effectively manage septic patients. However, for sepsis bundles to be effective, education and ongoing monitoring of their utilization is needed.
Conclusion: Traditional literature review gave supportive evidence that sepsis bundles do reduce mortality. To show stronger evidence based need in the effectiveness of sepsis bundle protocols, education on sepsis and the proper time initiative of sepsis protocols is imperati...
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Papathanassoglou, E. (2009). Sepsis bundles: time for a nursing initiative? Nursing In Critical Care, Vol. 14(4), 162-165. doi:10.1111/j.1478-5153.2009.00349.x.
Robson, W., & Newell, J. (2007, April). Severe sepsis: Do emergency departments offer patients optimal care? Emergency Nurse, Vol. 15(1), pp. 30-33.
Society of Critical Care Medicine. (n.d.). About the Surviving Sepsis Campaign. Retrieved from http://www.survivingsepsis.org/About-SSC/Pages/default.aspx
Society of Critical Care Medicine. (n.d.). Bundles. Retrieved from Surviving sepsis campaign: http://www.survivingsepsis.org/Bundles/Pages/default.aspx
Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock: 2012. (2013, February). Critical Care Medicine, 41(2), 580-637. Retrieved from http://www.sccm.org/Documents/SSC-Guidelines.pdf
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
normal saline, lactated Ringer solution, etc), volume expanders (e.g. albumin and others), antibiotics (e.g. cefotaxime, metronidazole, ciprofloxacin, cefepime, etc), and corticosteroids (e.g. hydrocortisone, dexamethasone, etc).Medications and surgery are often the most effective and most definitive treatments that a doctor or certified medical professional can give to a septic shock patient. However most of those treatments are administered in a hospital setting. Prehospital treatment and management for septic shock would include proper management of ABC’s (Airway, Breathing, Circulation), identifying the source of infection and treat accordingly if possible, and monitoring of the patient's vital signs. Not much definitively can be done in a prehospital setting but prehospital management is vital for patient survivability.Some complications that can occur as a result of septic shock include acute respiratory distress syndrome (ARDS), respiratory failure, heart failure, renal failure or injury, and abnormal blood clotting. Sepsis is listed by The Agency for Healthcare Research and Quality as the most expensive condition treated in the U.S. with an overall cost of more than $20 billion in 2011. Sepsis and sepsis
Daniels (2011) said that sepsis is one of the leading causes of death in hospital patient worldwide and severe sepsis causes around 37,000 deaths in the UK every year. Czura (2011) has defined it as a life-threatening condition that arises when the body’s response to infection injures its own tissues and organs and sepsis can be present in any patient and in any clinical setting. Based on the learner’s reading, she became aware of the importance of identifying the early inflammatory markers such as temperature less than 36 degrees or more than 38.3 degrees, heart rate greater than 90 beats per minute (bpm), respiratory rate greater than 20 breaths/minute, altered mental state, white cell count lesser than 4g/l or greater than 12g/l and blood glucose greater than 7.7 millimoles for non-diabetic patients. Presence of any two of these will follow further test and if sepsis is indicated then commence the sepsis six care bundle within the hour, contact the doctor and critical care outreach team. The sepsis six care bundle which was developed by Daniels et al (2010) has shown to improve delivery of reliable care across a range of clinical settings which is now used in many UK
Hospital must develop a team with consultant and multidisciplinary team for inputs clearly focussing on safe discharge to avoid hospital admission and fail discharges (Health Foundation 2013b; Fox et al 2013)
Pressure ulcer development in patients admitted to the ICU is classified under the Quality and Safety Education for Nurses (QSEN) topic of safety. Safety by definition reduces the risk of harm to patients and providers through system effectiveness and individual performance (Cronenwett et al., 2007). Patient outcomes significantly improve if pressure ulcers in the ICU are prevented; patient pain related to pressure ulcers is eliminated and the risk of infection associated with pressure ulcers is greatly reduced (Cooper, 2011).
Even with the ICU, the rates of in-hospital deaths from septic shock were usually more than 80%. This was just 30 years ago. Today the mortality rate is closer to 20 to 30% now. The nurses have advanced in training/technology, better monitoring, and immediate therapy to treat the infection and support failing organs (Angus, 2014). Since the death rates are decreasing, the focus is more on the recovery of the sepsis survivor. A patient who survives to hospital discharge after the diagnosis of sepsis, remains at an increased risk for death in the next following months and years. Those who are sepsis survivors often have impaired neurocognitive or physical functioning. They also have mood disorders, and a decreased quality of life (Angus, 2013). There are resources now available for pre-hospital and community settings. This will further improve timeliness of diagnosis and treatment (McClelland,
According to the Clinical Excellence Commission (2014), approximately 6,000 deaths per annum are caused by sepsis in Australia alone. These mortality figures are higher than breast cancer (2,864) and prostate cancer (3,235) combined (Cancer Australia, 2014). Despite advances in modern medicine and increased understanding of the need for timely recognition and intervention (Dellinger et al, 2013), sepsis remains the primary cause of death from infection worldwide (McClelland, 2014). Studies undertaken by The Sepsis Alliance (2014) and Schmidt et al, (2014) state that 40% of patients diagnosed with severe sepsis do not survive.
The purpose of this project is sepsis prevention and reduction of sepsis-related mortality in patients who are admitted into the ICU. Early detection and treatment of infection with antimicrobials and antibiotics, in addition to utilization of preventative measures should ultimately decrease antibiotic resistance, recurrences of resistant infection [that could potentially develop into sepsis], and decrease mortality in patients admitted to the intensive care unit (ICU). Education of clinicians, patients, and families are essential to stop the spread of infection that could ultimately result in the formation of sepsis.
Quality improvement issues in healthcare focus on the care that patients receive and the outcomes that patients experience. Nurses play a major advocacy role for ensuring safe and quality care to all patients. Also, nurses share the responsibility in leading the efforts in improving patient care in all settings (Berwick, 2002). One of the ongoing problems plaguing hospitals and nursing homes is the development of new pressure ulcers in patients after admission. A pressure ulcer can be defined as a localized area of necrotic tissue that is likely to occur after soft tissue is compressed between a bony prominence and a surface for prolonged periods of time (Andrychuk, 1998). According to the Centers for Medicare and Medicaid, patients should never develop pressure ulcers while under the supervision of any medical institution because they are totally preventable (Berwick, 2002). The purpose of this paper is to discuss the problems associated with pressure ulcers, examine the progress on improving this specific issue, and explain the Plan, Do, Study, Act cycle that I would use to improve patient care in this area.
According to the Center for Disease Control and Prevention (CDC) (2014), “the number of times people were in the hospital with sepsis or septicemia (another word for sepsis) increased from 621,000 in the year 2000 to 1,141,000 in 2008. Between 28 and 50 percent of people who get sepsis die”. Sepsis is a complication of serious infection and has a high mortality rate. The CDC (2014) also mentioned the high risk groups are immunocompromised, infants and children, elderly, and patients with chronic illness. According to Gauer (2013), “Sepsis is responsible for 20% of all in-hospital deaths each year (210,000), which
Infection prevention and control has become one of the growing advance practice professions in nursing. Preventable illnesses and the cost associated with treatment is the prime reason for the evolution of infection prevention (IP) as a speciality. This writer aspires to pursue a masters degree in infection prevention and control at American Sentinel University. As an advance practice professional, the infection prevention and control specialist must posses the necessary skills, knowledge, and experience established by the Certification Board of Infection Control and Epidemiology Inc. (CBIC). Additionally,
During clinical this week, the student nurse got the opportunity of an observational experience in a Specialty Care Unit. The student was directed to the Surgical Intensive Care Unit (SICU) to observe a patient that was critically ill and receiving extensive treatment. The student observed a nurse caring for a patient while administering therapeutic hypothermia after cardiac arrest.
Imagine going into the hospital for yourself or a loved one for treatment and instead coming out with more harm than you went in with. Patient safety and security is a huge aspect of the nursing field. When a patient is not feeling well it is the nurse’s job to make sure that the patient is as comfortable as possible despite the situation and most of all it is of even higher priority for the nurse to guarantee patient safety. Hospital time and stays can be very difficult and even upsetting to some patients. The idea of being in unfamiliar surroundings being care for by strangers may add to client’s bad feelings for, but it is still the healthcare team’s responsibility to make sure the patient’s main outcome is to feel better by time of discharge.
Severe sepsis and septic shock are major public health problems globally and are associated with substantial morbidity and mortality. The role of corticosteroid treatment in patients with severe sepsis and septic shock remains controversial despite the studies that have been using since decades.
The Importance of Pre-Hospital Emergency Care Robert A. Gaylor Waldorf University The Importance of Pre-Hospital Emergency Care In today’s society, the population of the United States is greater than ever before and continues to increase daily. According to Worldometers, the population of the United States in 2010 was 309,876,170 and as of July 11, 2016 has increased to 324,118,787 (U.S. Population (LIVE). (n.d.). That’s a 4.6% increase in approximately five and one half years. If this rate of increase continues, in ten years the population of the Untied States will be approximately 353,937,715. There are a vast number of people, both young and old, who suffer from stroke, heart attacks, and trauma on a daily basis. Throughout the course of