Tackling Sepsis: Nurses on the Front Line

As hands-on care providers, nurses are uniquely positioned to help patients win the fight against sepsis

Despite advances in the fight against sepsis, this deadly condition persists as one of healthcare’s most insidious challenges. An ever-present threat for acutely and critically ill patients, sepsis remains the third leading cause of death in the U.S., killing some 258,000 people each year. That’s more deaths than from prostate cancer, breast cancer and AIDS combined.

Equally alarming, sepsis is often as elusive as it is dangerous. It typically slips in quietly and takes hold swiftly – a menace where minutes matter. The latest research, guidelines and bundles continue to emphasize early detection and treatment of sepsis as key to increasing survival rates.

As the first line of defense for patients with sepsis, nurses are critical to the equation. Your ability to recognize the signs and deliver timely, effective care can mean the difference between life and death.

The Surviving Sepsis Campaign’s recent release of an updated Sepsis Bundle – emphasizing even earlier recognition and treatment – makes now an ideal time to revisit this ongoing medical threat.

To help you translate and apply current thinking about sepsis to your daily practice, AACN offers nurse-focused resources on our dedicated Sepsis Resources webpage. Here you’ll find highlighted sepsis resources selected by AACN’s clinical practice specialists, including journal articles, webinars, recorded conference sessions and a video interview with national sepsis expert Elizabeth Bridges, as well as a complete listing of AACN content on the topic.

What Nurses Can Do: Beyond the Bedside

We’ve also compiled a list of ways you can equip yourself for the fight against sepsis. Take these actions to increase your patients’ odds of survival:

  1. Stay current with definitions, guidelines, bundle recommendations and nursing care for patients with sepsis and septic shock.
  2. Discuss sepsis recommendations, updates and questions with your colleagues and providers.
    • Use available educational forums such as unit newsletters, emails, team huddles, grand rounds, case debriefs and journal clubs to talk about changes and research results.
    • Consider how current guidelines and updates may impact nursing assessment and priority interventions.
  3. Share resources with your colleagues that help you stay up-to-date on sepsis.
    • Identify materials available to share from the Surviving Sepsis Campaign.
    • Work with your educator, manager or clinical leaders on your unit to develop an information-sharing process.
  4. Think through your assessments, and use data to guide your decision making and patient care priorities.
    • When in doubt, validate your assessments and clinical decisions with a colleague (peer, APRN, other healthcare provider).
    • Actively develop your instincts for a high index of suspicion when caring for patients at risk for sepsis/septic shock.
  5. Volunteer for a unit-based committee or team, and work to address early recognition and management of patients with suspected sepsis/septic shock.
  6. Educate patients and families about their role in the prevention and early recognition of potential sepsis/septic shock.
    • Remember: handwashing, handwashing, handwashing!
    • Review the sepsis information for patients and families available from the Centers for Disease Control at www.cdc.gov/sepsis.

The New Hour-One Sepsis Bundle

Sepsis bundles identify groups of interventions that prompt adherence to current guidelines and improve patient survival. To remain effective, these bundles evolve in tandem with changes in our understanding of sepsis and how best to approach it.

In May 2018, the Surviving Sepsis Campaign issued a proposed new Sepsis Bundle as an adjunct to the 2016 Sepsis Guidelines. The biggest change in the proposed bundle is a shift in the timing of assessment and intervention, moving from three and six hours to one hour. Check the Surviving Sepsis website for materials you can share with colleagues, and watch for further publications reviewing the revised bundle. You can find a description of the proposed bundle revision in the May 2018 issue of Intensive Care Medicine.

An Expert Perspective: Elizabeth Bridges, PhD, RN

Our evolving thinking about sepsis means better protocols for identification and treatment, as well as the need to be diligent in following the latest research and evidence-based practice. We asked Dr. Elizabeth Bridges, nurse researcher and national expert on sepsis, about a common challenge facing healthcare providers when tackling sepsis.

Q: How do we evaluate new evidence that seems to contradict a current guideline?

A: “The thing about having new evidence is that we always have to ask questions. Things that seem very logical, with the test of time, may not work anymore.

“With sepsis, we’re talking about the early goal-directed therapy led by Dr. Emanuel Rivers in 2000. It was a different patient population, truly a really different intervention. Fast-forward to 2017. The patients that we’re studying today are not the same patients that Dr. Rivers was caring for in 2000. With patients that come in now, we identify sepsis, we get their antibiotics going, we get their fluids in. That’s pretty much standard practice, if you look at the characteristics of those patients.

“What we have to ask ourselves is, ‘Has the baseline changed?’ And, in the case of sepsis, the answer is yes, especially in terms of mortality rates — you can see that those have gone down — in addition to early glycemic control, ventilator management and prevention of ventilator-associated pneumonia.

“You always have to be willing to say, ‘Maybe we have new technology. Maybe we have a different way of thinking about patients. Is this good science?’ That is key — you have to be a critical consumer of the science. You have to say, ‘Is there enough solid science for us to pause and go hmm, we hadn’t thought about that yet, maybe it’s time to change our practice.’ In this day and age, I think we as clinicians must be smart consumers of evidence.”

To hear more from Dr. Bridges, visit AACN’s Sepsis Resources webpage.

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