Sepsis protocols causing a future superbug??

[Alexx_xox]

I am sure we all work at a hospital where code sepsis's are now a huge deal as evidence has shown that preventing septic shock helps increase the chances of survival. **insert shocked face** (like we all didn't know that.)

Anyways, we all know that is true and people with the potential of becoming septic should be treated with antibiotics and fluids STAT. Although this protocol is probably saving lives all over the U.S., I also think it may be the beginning of a superbug.

Many people that walk through the ER are going to flag for sepsis, but does that truly make them septic?

What is your guys' hospital protocol when it comes to treating sepsis??

I am afraid that if we continue to treat everyone as a code sepsis and load them with tons of antibiotics, we are running the risk of future superbugs which won't respond to these antibiotics.

Any opinions out there?? How can we effectively treat sepsis and distinguish septic from non septic patients to help prevent a future superbug?

Let me know your opinions, or maybe what your guys' hospital protocols are when it comes to a code sepsis.

[KatieMI, BSN, MSN, RN]

JKL33,

the problem is, mentioning "infection", or better yet "sepsis", brings more $ through billing. Even if it is only "suspicion". So, we surelu can hope. But that's about all-mighty $$$.

[dbabz]

According to my source above, SIRS is dead and not existing anymore.

Re. fluid overload - oh, yes, man. At least third of my hospital census since January consists of people with classic set of CHF, COPD, HTN, CRF III+ who came in ER with whatever and got 3 to 4 boluses, a liter each, for "dehydration" and "suspected sepsis", then a tankload of Lasix for "elevated BNP" and then good load of vancomycin for continuing "suspucion of sepsis". They got it all within a couple of hours, then dumped on me to fight fluid shifts, lytes derangement, ets. in the setting of their kidneys going to give up and whatever else with what they actually got there.

I tried to at least tell ER PAs not to dump vanco as tap water and got long lecture at 2 AM about WBCs being 12.200 "so important" because their criteria state 12 as cutoff. Lab norm cutoff 12.5.

Thank you...again...I read the article more carefully and I took away the following: There will be two designations; sepsis and septic shock. SIRS criteria are "unhelpful." (agreed.) New criteria for sepsis include altered mentation, tachypnea and hypotension. New criteria for septic shock are persistent hypotension in spite of fluid resuscitation (thus the need for vasopressors) and hyperlactemia. Also, this is all very patient-specific. Makes more sense to me than the process I've seen so far. Thanks again!

[KatieMI, BSN, MSN, RN]

Thank you...again...I read the article more carefully and I took away the following: There will be two designations; sepsis and septic shock. SIRS criteria are "unhelpful." (agreed.) New criteria for sepsis include altered mentation, tachypnea and hypotension. New criteria for septic shock are persistent hypotension in spite of fluid resuscitation (thus the need for vasopressors) and hyperlactemia. Also, this is all very patient-specific. Makes more sense to me than the process I've seen so far. Thanks again!

It is so amazingly patient-specific that I spent an hour convincing ER PA-C and then attending that patient with terminal liver cirrhosis, hepatorenal syndrome, afib with RVR in 180 on amio drip, huge ascitis and with all of that drunk as a cold stone does not authomatically "satisfy criteria" and deserves transfer to advanced metabolic care ICU, not our "normal" MICU due to his "sepsis".

Poor dude still got vanco in loading dose. I'll let nephrologist to take the business from here even before next labs come.

[dbabz]

It is so amazingly patient-specific that I spent an hour convincing ER PA-C and then attending that patient with terminal liver cirrhosis, hepatorenal syndrome, afib with RVR in 180 on amio drip, huge ascitis and with all of that drunk as a cold stone does not authomatically "satisfy criteria" and deserves transfer to advanced metabolic care ICU, not our "normal" MICU due to his "sepsis".

Poor dude still got vanco in loading dose. I'll let nephrologist to take the business from here even before next labs come.

Wow! When I grow up, I wanna be you.

[KatieMI, BSN, MSN, RN]

Wow! When I grow up, I wanna be you.

Welcome to the wonderful world of Advanced Practice Nursing, my friend :)

Do your assessments, ask questions, seek answers, get Lange's patho, pharm, micro and biochem books (yes, they are for med schools, and this is okay:)) and you'll get there!

[dbabz]

Welcome to the wonderful world of Advanced Practice Nursing, my friend :)

Do your assessments, ask questions, seek answers, get Lange's patho, pharm, micro and biochem books (yes, they are for med schools, and this is okay:)) and you'll get there!

Just added to my wish list. Need a paycheck before making the actual purchase. Again, many, many thanks for your help. I promise to pay it forward.

[dbabz]

From today's Morning Edition on NPR:

Researchers Test Vitamin C Treatment For Sepsis : Shots - Health News : NPR

I find it difficult that a patient with kidney and liver failure recovered completely, but there is some indication of promise in the story.

[Eris Discordia BSN, RN]

Amen, vanilla bean!

But I just couldn't resist:

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Ironically, this is EXACTLY how it is done at my hospital! An overhead page, followed by room number. It pages lab STAT to the bedside, as well as a pharmacist, and a RN supervisor. Pharmacist has the sepsis decision tree and initiates standing orders from there with their tablet. It's interesting to be involved in.

Code Sepsis also gets called overhead to specific ER beds. I'm not sure if lab is really needed there, or how it goes down in the ER, but on the floor, we get lab, pharmacy, and a supervisor at least to show up. Hospitalists sometime show up, but not always, so it's not a requirement. The pharmacist takes the lead in contacting the physician, if not done already by nursing, to go over the decision tree and review the standing orders and make changes, as needed, for medication/fluid orders (in light of drug allergies or other extraneous scenarios). Our pharmacy team is pretty darn awesome.