Abstract
This paper focuses on the discussion of the recent Bill regarding the introduction of sepsis protocols in New Jersey hospitals. No. 4678 state of New Jersey, 216th legislature sponsored by six assembly members presents a relevant review of the current health care problem associated with sepsis mortality and morbidity in adults and infants. The Bill declares that there is an urgent need to improve early recognition of the mentioned disease based on appropriate evidence-based diagnostics and treatment options. Considering that sepsis is one of the leading death-causing diseases in New Jersey as well as failure to address it, the selection of the identified Bill seems to be evident. Consistent with other interested stakeholders such as nurses, it is essential to note that the implementation of this Bill would enhance the existing clinical practice guidelines, enrich nursing profession, and clarify the role of nurses in addressing sepsis.
New Jersey Legislative Process and Difference Between the State and Assembly Versions of the Bill
The Bill under consideration, no. 4678 state of New Jersey, 216th legislature, requires hospitals to establish appropriate early sepsis recognition protocols. The review of this Bill shows that the legislative process adopted in New Jersey targets only the given state, while Congress covers all US states. The legislative branch of New Jersey creates laws in accordance with the emerging political, economic, social, and health care needs of citizens as well as adjusts old ones (“Bills, code, laws,” n.d.). The process of creating new bills consists of identifying assemblymen and assemblywomen sponsored the given bill, clarification of the bodies enacting it, the provision of the key points and aims, and the statement summarizing the Bill. The current Bill is sponsored by six assembly members from different districts of the state and enacted both by the General Assembly of the State of New Jersey and the Senate (“Assembly, no. 4678 state of New Jersey, 216th legislature,” 2015). There is only one version of the text of the Bill that is as introduced by the assembly members.
Rationale and Impact on Health and Welfare of the Public
Sepsis, severe sepsis, and septic shock are inflammatory conditions that result from a systemic response of a body to a bacterial infection. In such conditions, there is a critical decrease in tissue perfusion, while acute failure of many organs including lungs, kidneys, and liver can occur (New Jersey Hospital Association, n.d.). Pediatric sepsis is regarded as an invasive infection, usually bacterial, that develops in the neonatal period. Symptoms of sepsis are manifold and include a decrease in spontaneous activity, poor sucking during feeding, apnea, bradycardia, fluctuations in body temperature, respiratory distress, vomiting, diarrhea, bloating, and increased nervous excitability. Early diagnosis is important and requires knowledge of risk factors, especially in newborns with low birth weight. In response to the identified health care concerns, the mentioned Bill was introduced, thus promoting early sepsis detection and adequate treatment.
In order to justify the selection of no. 4678 state of New Jersey, 216th legislature, it is also essential to point out the impact of sepsis rates in New Jersey with regards to welfare of the public. Of the leading causes of death in the above state, sepsis takes the eighth place in adults, while it is the most common death cause in newborns. More to the point, as statistics shows, “New Jersey’s statewide inpatient severe sepsis mortality rate is close to 30 percent, with a national rate ranging from 20 to 50 percent” (New Jersey Hospital Association, n.d., para. 1). Currently, sepsis affects negatively patients’ health outcomes and also sets additional burden on costs of the treatment. Since the existing protocols cannot ensure adequate recognition of this disease both in adults and infants, it is essential to consider the Bill as a feasible and relevant solution to the problem. By mandating sepsis protocols, it is possible to achieve greater sepsis recognition and increase patients’ chances to survive. The implementation of the evidence-based interventions in combating sepsis is likely to significantly improve the above indicators and welfare of the public.
The strongest points of the Bill include a precise focus on the target populations and distinguishing between adults and infants, who need specific interventions. Another advantage is associated with providing the convincing rationale based on statistics from official sources for the adoption of sepsis protocols (“Assembly, no. 4678 state of New Jersey, 216th legislature,” 2015). The fact that it strives to support evidence-based interventions as well as consider ever-changing environment also demonstrates its benefits. Among the limitations, one may note that the Bill targets only the state of New Jersey and cannot be generalized to the whole US context. Another limitation refers to such an issue as control of sepsis protocols; namely, it is not stated how their quality would be verified. It would be better if the mentioned point was clearly identified in the text of the Bill to ensure long-term cooperation between the state’s hospitals and the department of health care. No financial statement is provided.
Personal Position and Healthcare Stakeholders’ Potential Views
In my point of view, sepsis is a life-threatening disease, attention to which should be increased in public health. In particular, it seems that the described no. 4678 state of New Jersey, 216th legislature would contribute to public health regarding sepsis identification and treatment. The review of the contemporary situation provided in the mentioned legislation shows that early administration of antibiotics may help patients to overcome it easier with fewer complications. As for severe sepsis and sepsis shock, I believe that the Bill would also improve the existing treatment methods by adjusting them in accordance with the most effective evidence-based clinical practical guidelines.
Other health care stakeholders may view this legislation as an attempt to make sepsis practice closer to its theory. For example, if I were to contact the American Nurses Association or New Jersey Hospital Association, I would more likely receive supportive responses from the representatives of these organizations. Since both of them pursue high-quality patient care, better patient outcomes and satisfaction, as well as evidence-based solutions, the Bill under consideration would be a great stimulus and foundation for achieving the above goals. If I were to contact specific interested stakeholders, I would ask for conversations with nurses as the direct care providers, who may critically assess the potential results of implementing the Bill through communicating with patients and evaluating their medical records. In other words, they may collect both objective and subjective data regarding patients with sepsis and analyze it accordingly, thus providing valuable evaluation and recommendations for further work on this health care issue. It should also be emphasized that these stakeholders would anticipate the decreased sepsis mortality rates, especially among infants.
Impact on Nursing and Nurses
Nursing profession aims at continuous improvement, and the given Bill would contribute to such an initiative. In particular, timely screening of severe patients who are at risk of infection, especially patients hospitalized in the intensive care units (ICUs), would be provided for early detection of clinical signs of sepsis and the earliest possible initiation of adequate antimicrobial and pathogenetic therapy. As for pediatric care, the Bill would impact positively by increasing survival rates in infants based on sepsis protocols. Since the latter would be based on recommendations based on evidence, patients with sepsis, severe sepsis, and septic shock would receive more appropriate nursing care. The profession of nursing would become more patient-centered and comprehensive, thus resulting in better patient health outcomes.
Specifically to nurses, the Bill would promote combined treatment of a physician and a nurse, leading to coherence of disease identification, treatment, and follow-up. The standardization of sepsis protocols would also direct nurses during the selection of proper strategies and techniques of working with a particular patient, be it an adult or an infant. In other words, nurses would receive clear guidelines on how to act in one or another situation while encountering patients with sepsis or the associated symptoms while the diagnosis is not yet specified. The Bill would be helpful to assist nurses in being more attentive and sensitive to patients’ needs, values, and expectations regarding health care services. In a broader sense, sepsis protocols introduced in New Jersey hospitals are likely to increase the level of awareness in care providers, patients, and health department. One may suggest that the implementation of no. 4678 state of New Jersey, 216th legislature would evolve new opportunities in detecting and treating sepsis in adult and pediatric care due to relevant guidelines.
Congressman, State Senator, and Two Assembly People in My District
Leonard Lance is a Congressman in my district 23 (Warren), and Michael J. Doherty is a State Senator. John DiMaio and Erik Peterson are Assembly People.
References
Assembly, no. 4678 state of New Jersey, 216th legislature. (2015). Web.
Bills, code, laws, regulation, & letter writing. (n.d.). Web.
New Jersey Hospital Association. (n.d.). Sepsis. Web.