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
Unfortunately, infection places people in the hospital and infection is developed in the hospital. Two ways to contract sepsis are through hospital-caused infection, like in Amy Widener’s case, and through an infection caused by outside sources, for example a urinary tract infection in an elderly person. Everyone is capable of getting sepsis however cases appear most often in children under one year of age and in elderly older than sixty-five years. This is due to the body’s immune system being weaker in these demographics than in a person that has a built-up and strong immune system (“Sepsis Questions and Answers”). Sepsis occurs because of infection so the immune system plays a large role in the body’s defense mechanism. When people with already compromised immune systems develop an infection or are in an environment that infection is likely to occur, for example an unsanitary procedure in a hospital, then the body’s chances of being able to fight the infection off are greatly
For the purpose of this assignment, a case study has been selected in order to relate the signs and symptoms of sepsis to the underlying pathophysiology of the sepsis continuum. In order to maintain patient confidentiality, names dates and times have been changed or omitted, in line with Australian Nursing and Midwifery Code of Professional Conduct (ANMCC, 2008).
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
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
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)
As an ICU nurse I constantly watch how patients develop pressure ulcers, a pressure ulcer is an area of skin that breaks down due to having constant friction and pressure, also from having limited movement and being in the same position over a prolonged period of time. Pressure Ulcers commonly occur in the buttocks, elbows, knees, back, shoulders, hips, heels, back of head, ankles and any other area with bony prominences. According to Cox, J. (2011) “Pressure ulcers are one of the most underrated conditions in critically ill patients. Despite the introduction of clinical practice guidelines and advances in medical technology, the prevalence of pressure ulcers in hospitalized patients continues to escalate” (p. 364). Patients with critical conditions have many factors that affect their mobility and therefore predispose them to developing pressure ulcers. This issue is significant to the nursing practice because nurses are the main care givers of these patients and are the ones responsible for the prevention of pressure ulcers in patients. Nurses should be aware of the tools and resources available and know the different techniques in providing care for the prevention of such. The purpose of this paper is to identify possible research questions that relate to the development of pressure ulcers in ICU patients and in the end generate a research question using the PICO model. “The PICO framework and its variations were developed to answer health related questions” (Davies, K., 2011).
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.
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,
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.
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,
Secondary:Curtis, L. (2008). Prevention of hospital-acquired infections: review of non-pharmacological interventions. Journal of Hospital Infection, 69(3), 204-219. Revised 01/20
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
“ 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 ...
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