Sepsis Sleuth

RN1982 · Jun 1, 2008

Yes, be a sepsis sleuth. That's the craziest thing I have heard. Walk around all "charlie's angels"-like looking for bad guy Sepsis.

aeauooo · Jun 1, 2008

Two weeks ago an MD refused to move a patients who was extremely hypotensive until after we called 2 rapid responses on the guy. Now today I had another pt who is just obviously septic.... Positive BC, hypotensive, HR in the 130s... but yet won't transfer to the unit

Talk to your charge nurse and/or nursing supervisor.

Report all of the signs of sepsis to the physician - not just the fact that the patient is hypotensive and tachycardic, but what symptoms s/he has and what s/he looks like. Septic patients look sick - pale, restless, lethargic, diaphoretic, cold to the touch.

DOCUMENT!

Paint a very clear picture of what is going on with your patient when you report your findings and when you document.

Docs will learn from an "I told you so" when your patient goes south. Your documentation puts her/his butt in a sling - not yours.

It's a bad situation for the patient you are taking care of at the time, but it will give you much more credibility with that doc the next time it happens.

Blee O'Myacin, BSN, RN · Jun 1, 2008

So at our hospital they want you to be a "sepsis sleuth." They have the symptoms of sepsis posted all over the place. But yet lately I've had a serious problem with doctors not wanting to tx septic patients to the unit. Instead they leave our hypotensive, tachycardic, feverish patients on the floor for us to manage... These patients are extremely sick and high maintenance with fluids, tons of antibiotics, and pain/nausea issues. Two weeks ago an MD refused to move a patients who was extremely hypotensive until after we called 2 rapid responses on the guy. Now today I had another pt who is just obviously septic.... Positive BC, hypotensive, HR in the 130s... but yet won't transfer to the unit...
What is the point of me being a sepsis sleuth if no one is listening???
Tiger

Does your hospital have quantitative guidelines for upgrading a patient to the unit with sepsis? Standard of care for sepsis usually involves pressors for the hypotension, and there comes a point where you can only fluid rescusitate so far before the patient goes into CHF or pulmonary edema and needs to be intubated. Any lactate levels or ABGs ordered on the patient you mentioned?

If you have a doc that refuses to move a patient that meets ICU criteria, then you need to go up the chain of command. If it's a resident, call the attending and be sure to keep the nursing supervisor in the loop.

Good luck sleuthing...

Blee