Discussion: Early detection and prevention of Sepsis
Discussion: Early detection and prevention of Sepsis
Literature review for college level nursing
title Early detection and prevention of Sepsis
focusing on screening, detection and prevention
1) Overview of disease process
2) How to assess signs and symptoms
3) Treatment and prevention of sepsis
METHODOLOGY
LITERATURE REVIEW
CONCLUSION
REFERENCES
Please use the attached references
Ask the Experts
QAre there time frames related to the sepsis screening criteria? For example, what window of time would qualify to meet criteria for systemic inflammatory response syndrome? Would you expect increases in heart rate, respiratory rate, and body tempera- ture measurements to occur simultaneously or within 2 to 4 hours? Would the change in
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2 groups of patients in general care areas; one group was automat- ically screened with the prediction tool and one group was not. The tool algorithm incorporated hemo- dynamic parameters that included the shock index (heart rate/systolic pressure) and the mean arterial pressure. Laboratory values moni- tored were white blood cell count; neutrophil count; bilirubin, albu- min, sodium, and hemoglobin lev- els; and international normalized ratio. This computerized prediction tool would gather the data from the electronic medical record and the laboratory interface. The sam- ple size was small, but the study did show an increase in the number of interventions and earlier transfer to a higher level of care for patients in whom the computerized predic- tion tool was used. Length of stay and hospital mortality were the same in the 2 groups.
Croft et al3 compared a com- puter versus a paper system for recognizing and managing sepsis. The hospital mortality rate was significantly lower in the group screened with the computer-based system than in the group screened with the paper system. Their com- puter sepsis application provided continuous recognition of sepsis onset based on the electronic medi- cal record. The scoring system used
white blood cell count be within 12 to 24 hours of elevated heart rate, respi- ratory rate, and body tem- perature? We are looking at using the electronic record to capture an alert for clinicians and won- dered if there were any standards for this. Discussion: Early detection and prevention of Sepsis
A Rosemary Lee, DNP, ARNP-BC, CCNS, CCRN, replies:
In the 2012 Surviving Sepsis Guidelines,1 it is recommended to routinely screen potentially infected patients for sepsis. The sooner sepsis is diagnosed, the sooner the 3-hour bundle can be initiated. The guidelines further recommend the administration of appropriate antibiotics within the first hour of recognition of severe sepsis or septic shock. With the diagnosis of septic shock, each hour of delay in administering antibiot- ics increases the mortality rate.
Sawyer et al2 used a real-time prediction tool to detect sepsis in patients who were not in the intensive care unit. In that pro- spective pilot study, they compared
Time Frames for Sepsis Screening Criteria
Author Rosemary Lee is a clinical nurse specialist in the critical care unit at Homestead Hospital, Homestead, Florida, part of Baptist Health of South Florida. She is also adjunct faculty at the Nova South Eastern University College of Nursing. Corresponding author: Rosemary Lee, DNP, ARNP-BC, CCNS, CCRN, Critical Care Unit, Homestead Hospital, 975 Baptist Way, Homestead, FL 33033 (e-mail: [email protected]).
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for this application was the Mod- ified Early Warning System–Sepsis Recognition Score (MEWS-SRS). The application was surveillance followed by diagnosis of sepsis and protocol orders. This sys- tem was used in a surgical inten- sive care unit.
Both of these studies mention “real time” and continuous surveil- lance, but not the time frames you asked for. The Sawyer study states
patients present with a con- stellation of abnormal vital signs and laboratory find- ings (fever, hypothermia, tachycardia, tachypnea, abnormal white blood cell count, creatinine, liver func- tion studies) and progres- sion from a syndrome of abnormal vital signs and laboratory values to organ dysfunction and shock.
The inference here is that sepsis can be manifested in myriad ways and as yet no standard has been set for the time frames you seek.
The frequency of screening varies by each accepted hospi- tal practice. When nurses need to manually input criteria into a computer screening tool, the screening is done anywhere from every 4 hours to every 12 hours. This screening and data entry increase the workload for the nurse. Early warning systems that are automated, continuously survey- ing the electronic medical record and laboratory interface, and pro- vide an alert via e-mail, beeper page, text, or phone call would be the most advantageous for
early identification of sepsis. Cur- rently no set standards have been reported in publications or by the Surviving Sepsis Campaign.4
Not to be deterred, I did con- sult with Donna Lee Armaignac, PhD, RN-CNS, CCNS, CCRN, Director of Best Practices for our Telehealth Department (written communica- tion, March 9, 2015). She is active in our hospital system–wide sepsis team. She stated,
We are testing independent and combined contributions of various variables’ sensi- tivity, specificity, positive predictive value, and nega- tive predictive value in real time. Answering her pre- cise question of the time win- dows is what we are testing, the sweep is every 6 to 7 min- utes, the vital signs (all that are available, including SpO2 [oxygen saturation shown by pulse oximetry] etc) will always bring the most recent in a live feed, also live data from lab, WBC/diff [white blood cell count/differential count], lactate, procalcitonin as it becomes available. The organ dysfunction criteria [are] almost useless, as the horse is out of the barn, so to speak. So we are focusing more on the signs and symp- toms of infection with SIRS [systemic inflammatory response syndrome]. We are writing natural language processing for infection cri- teria, CXR [chest radiogra- phy], cultures, orders for antibiotics, and so on.
As you can see, more research is needed in this area so that stan- dards can be developed. Perhaps your project could be developed into a research study and you could add to this body of knowledge.
Financial Disclosures None reported.
References 1. Dellinger RP, Levy MM, Rhodes A, et al.
Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012. Crit Care Med. 2013; 41(2):580-637.
2. Sawyer AM, Deal EN, Labelle AJ, et al. Implementation of a real-time computer- ized sepsis alert in nonintensive care unit patients. Crit Care Med. 2011;39(3):469-473.
3. Croft CA, Moore FA, Efron PA, et al. Com- puter versus paper system for recognition and management of sepsis in surgical intensive care. J Trauma Acute Care Surg. 2014;76(2):311-319.
4. Surviving Sepsis Campaign. http://www .survivingsepsis.org/Guidelines/Pages /default.aspx. Accessed March 23, 2015.
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