What do you know/have you been taught about Sepsis?

[clemmm78]

Hi all,

I am working on a big (BIG) project on sepsis. It's an international endeavor to reduce the number of sepsis deaths world wide. Surprisingly, in the United States, more people die of sepsis than you can imagine, because frequently, the cause of death isn't written as sepsis or septic shock, but as infection due to XYZ or organ failure due to ABC.

I have been speaking with the founders and bosses of this project about the importance of bringing the nurses on board for recognizing sepsis and teaching about it to patients and families. They agree, they know that the nurses are the front line. :)

So, I need to know from you, on the floors, in the units, in the homes, wherever else - what do you know about sepsis? What did you learn about sepsis that you didn't know until something happened? Have you ever had a patient who you knew was going septic but it wasn't picked up in time.

I'm looking for insight as to what we need to focus on in terms of teaching nurses, perhaps developing CME.

Any help would be great.

Many thanks,

Marijke

[combinate]

How is hospital performance (early ID and Pt outcome) measured, and how are hospitals performing?

[Larry3373]

I love the YouTube.com video "I'm Bringing Sepsy Back". Really helped me to remember what to look for. In terms of what I knew beforehand, my facility (work for an HCA hospital) gives teaching modules on sepsis/sirs and we screen for it each shift. We will do blood cultures and start appropriate abx coverage if it is a new problem. Then we do fluid resuscitation and start levophed if needed. We also look for a source (infected picc line, uti, etc). For assessment I'm looking for a fever, tachycardia, warm lower extremities, and hypotension.

[Been there,done that, ASN, RN]

I know my father died of sepsis.. loooong story. Indeed ,his cause of death was listed as heart failure. A LAME excuse from the attending, accepted by the coroner.

Since then, I have worked in facilities where a rapid response is triggered by many variables.. in the EMR.

This of course does not COMPARE to the bedside nurse's observations. Any WBC count less than 4 of greater than 12, temp over 99.4 or less than 97.3, heart rate consistently over 90, respirations over 20, or any change in mental status can signal sepsis.

Best of luck with your endeavor.

[combinate]

Hospital or unit performance: % Pts w trigger criteria that receive the complete sepsis treatment/care "bundles" in the respective time periods (3 and 6 hours). Would this make sense?

Then; # hospital days of those Pts. triggering the sepsis bundles; % of readmits within 30 days of discharge, and probably % of deaths in these patients triggering sepsis treatment.

I made these up. Does anyone have a couple good references that define how the leading institutions measure hospital performance?

[Oh'Ello, BSN, RN]

I'm confused about what you mean when you say that there isn't a "universal definition" of the problem. I thought It was fairly straightforward. Colonized bacteria in the blood > inflammatory response > cytokine release > capillary leak > hypotension >tissue destruction >anaerobic metabolism > hypo perfusion > coagulopathy > mods. Serial lactate draws. Crystalloid fluid recitation with 30mL/ kg within 3 hours, Pressor initiation for poor 'tensive response. Cultures and broad spectrum antibio administration within 3 hours. support support support.

[SierraBravo]

I know that almost always, when I have a resident at end-of-life, they end up with a "fever of unknown origin" for which no organism can be identified and the cause of death is sepsis.

Low-grade fever, no s/s of infection otherwise, old person = sepsis. IME.

At end of life, patients will more often than not spike a severe fever (>40*C). It's likely not due to sepsis but rather the normal physiology of the body during the process of death.

[BrnEyedGirl, BSN, MSN, RN, APRN]

Sepsis education is a big deal where I work. It is a CMS core measure and we begin screening at triage. We identify severe sepsis vs septic shock and treat accordingly. We have screening tools built into our EMR and we have a sepsis team protocol that alerts lab, xray, physicians and nurses that the pt is on sepsis protocol,... all of this before they leave the ED. Since this is affecting reimbursement I would think all hospitals would be doing this.