SE5h, Sepsis Education.pdf. Surviving Sepsis

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1 Surviving Sepsis 1

2 Scope and Impact of the Problem: Severe sepsis is a major healthcare problem that affects millions of people around the world each year with an extremely high mortality rate of 30 to 60 percent. Mortality from sepsis is greater than breast cancer, lung cancer, and colon cancer combined and is the number one cause of death in the non-coronary ICU. The incidence of severe sepsis is expected to double over the next 25 to 30 years. 2

3 Sepsis is a range of clinical conditions caused by the body s systemic inflammatory response (SIRS) to an infection. Severe sepsis is a condition in which sepsis is accompanied by organ dysfunction or failure. SE5h, Sepsis Education.pdf Sepsis can rapidly progress to severe sepsis to septic shock within 24 hours if left untreated. 3

4 The Sepsis Continuum SIRS Sepsis Severe Sepsis Septic Shock A clinical response arising from a nonspecific insult, with 2 of the following: T >38.3 o C or <36 o C HR >90 beats/min RR >20/min or PaCo2 <32 WBC >12,000/mm 3 or <4,000/mm 3 or >10% bands SIRS with a presumed or confirmed infectious process Sepsis with organ failure Refractory hypotension SIRS = systemic inflammatory response syndrome Chest 1992;101:

5 Managing Sepsis/Severe Sepsis The rapid diagnosis and management of sepsis is critical to successful treatment. The sepsis patient is usually already critically ill and requires immediate attention to avoid rapid deterioration; therefore, it is necessary to treat the patient at the same time as confirming the diagnosis. The management of sepsis patients involves a variety of therapeutic interventions. Treatment is more likely to be effective, and severe sepsis avoided, if appropriate therapy is used early. Once diagnosed, the goal of therapy is to eliminate the underlying infection with antibiotics. 5

6 Goals of the UCI Sepsis Response Team Build awareness of sepsis. Improve diagnosis Increase the use of appropriate treatment Educate healthcare professionals Develop guidelines of care Facilitate data collection for the purposes of audit and feedback Reduce mortality rates 6

7 Severe Sepsis is a Medical Emergency With acute Heart attack Time is Muscle SE5h, Sepsis Education.pdf With acute Stroke Time is Brain 7

8 With acute Sepsis Time is Organs 8

9 9

10 What will we do at UCI to improve our patients outcomes? SE5h, Sepsis Education.pdf 10

11 What is my role as the nurse? SE5h, Sepsis Education.pdf You are the closest in proximity to the patient, take a lead in assessment! Stop the progression of Sepsis and promote early detection and early treatment. Screen for sepsis once a shift and PRN Suspect sepsis if SIRS criteria is met and there is known or suspected infection When the patient screens positive for sepsis notify the doctor providing SBAR. Expect orders for the sepsis bundle (labs: STAT lactate and blood cultures, oxygen, fluids, close monitoring of urine output, start antibiotics within 1 hour.) If the physician is unable to come to see the patient or there is no response from the primary team within 15 mins call the Attending. If there is no primary team response within 30mins (total)and the patient displays signs of organ dysfunction, or deteriorating status, call the Rapid Response Team. Increase the assessment frequency and monitor closely if the physician diagnoses confirms sepsis or severe sepsis. 11

12 Sepsis Screening Tools have been shown to improve the early diagnosis of sepsis and severe sepsis. The University of California Irvine Sepsis Screening Tool will be utilized for every inpatient. The RN will Screen every inpatient, every shift ( and PRN) for sepsis. ( Excluded Comfort care patients and pts. < 18 years old) 12

13 13

14 Components of the Sepsis Screening Tool Step #1- Screen for SIRS ( Systemic Inflammatory Response) Leave blank if SIRS criteria are absent Place a check mark if positive ( may write in values) 14

15 Step #2 Evaluate if patient has Suspected or Documented Infection: Examples: Pneumonia, UTI, abdominal pain, diarrhea, meningitis, skin/soft tissue or catheter site inflammation, joint swelling, purulent wound, endocarditis risk factors, implantable device 15

16 Negative Screen for Sepsis: If SIRS criteria are absent or only one criteria is present, check the Negative screen for sepsis and rescreen next shift. If 2 or more SIRS criteria are positive but there is no known or potential source of infection, check the areas positive for SIRS and the Negative screen for sepsis box. Rescreen next shift. 16

17 Positive Screen for Sepsis: If # 1 has 2 or more positive and # 2 is positive, The patient has screened positive for Sepsis. Proceed to Step #3 Screen for Severe sepsis ( signs of organ dysfunction check #3 if positive) 17

18 18

19 Once the patient has screen positive for sepsis or severe sepsis, call the physician utilizing the SBAR Report on the bottom of the screening tool. Document the name of the physician notified and the time the physician was notified. 19

20 SEPSIS RESUCITATION BUNDLE: A bundle refers to a group of interventions that should be initiated together to have better patient outcomes than if the intervention alone is implemented separate from one another. TREATMENT: 1.Early initiation of supportive care to correct physiologic abnormalities : 1.Administer oxygen for hypoxemia 2.Administer Fluids for Hypotension 2.Obtain stat serum lactate and blood cultures. 3.If MAP <65 or Lactate >4 administer crystalloids/colloids 4.Start Antibiotics within 1 hour 5.Monitor CVP if in the ICU and keep CVP >8 or >12 if on mechanical ventilation 6.Maintain MAP>65 may need to transfer to the ICU and initiate Vasopressors, PRBC, Inotropes and depending on situation, consider steroids. 7.Maintain glycemic control <180mg/dl. 20

21 Sepsis Algorithm 21

22 22

23 For Severe Sepsis/Septic Shock (ICU only) Maintain Therapeutic Endpoints 23

24 Therapy Across the Sepsis Continuum SIRS Sepsis Severe Sepsis Septic Shock * Early Goal Directed Therapy Antibiotics and Source Control Chest 1992;101:

25 Time to antibiotics=a critical determinant of survival SE5h, Sepsis Education.pdf Mortality risk increases 7.8% per every hour of delay. Reminding physicians to use the sepsis order set will improve the turn-around time of broad spectrum antibiotics. 25

26 The patient screened positive now what? The physician diagnosis is SIRS- not sepsis. The RN will resume screening each shift. The physician confirms the diagnosis of sepsis/severe sepsis SE5h, Sepsis Education.pdf The RN will rescreen in 24 hrs. but will not need to re-notify the physician for 7 days unless pt. is deteriorating or showing new signs of organ dysfunction. 26

27 When the sepsis screening form is complete, return the yellow copy to route 201. For positive Sepsis Screens: Enter sepsis nurse referral in Quest. For Questions: please contact Kristi Hare Sepsis Project Manager 27

28 28

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