Introduction
Sepsis is a serious healthcare condition that affects many patients admitted in the emergency department. It arises from the body’s systematic response to infection. It is also defined as the organized inflammatory response initiated by an infection in the host (Kleinpell, Aitken & Schorr, 2013). It affects pediatric, neonatal, and adult patients. Severe sepsis is one of the health conditions characterized by complications arising from acute organ dysfunctions. In most cases, the patients require organ system support. The support is provided through vasopressin therapy and mechanical ventilation.
Severe and shock sepsis are associated with high mortality rates due to their high incidences and hospitalization rates. The situation persists in spite of improvements in the management of infections. There are various cellular actions that take place as a result of inflammation. One of them is weakened perfusion (Kleinpell & Schorr, 2014). The complications can lead to organ failure (Kleinpell & Schorr, 2014).
In this paper, the author will analyze the effective use of sepsis protocols in the emergency department. The analysis is carried out in the context of evidence-based practice in nursing and healthcare. To this end, the various protocols associated with sepsis will be reviewed. The impacts of this approach on nursing, delivery of care, expenditure, and outcomes will also be evaluated. Six articles will be reviewed to provide this information. The data in the six primary resources will be supported by information from other reports. Improving the effectiveness of the protocols put in place in the emergency department can help to save lives. In addition, the mortality rates associated with sepsis can be reduced (Czura & Distlerath, 2010).
Synthesis of Articles
Protocols in the Emergency Department
According to Patocka, Turner, Xue, and Segal (2014), there are a number of procedures used to manage sepsis in a healthcare setting. The view is supported by Sweet et al. (2010) in their study. The various protocols are highlighted in this research undertaking. According to Sweet et al. (2010), these elements touch on time, treatment, data collection, and monitoring of the affected patients. For example, when a patient first arrives in the hospital, operational procedures dictate the steps to be followed in diagnosing them. If the protocol is followed effectively, sepsis can be diagnosed at an early stage. As such, treatment can be started immediately.
At times, it is important to make changes to a given protocol to enhance its effectiveness. To achieve this, it is important to put in place an implementation plan to outline the changes to be made to the already existing protocols and sepsis care initiatives (Turi & Ah, 2013). The next step involves assembling key stakeholders responsible for the execution of the new procedures.
Sepsis Protocols and Evidence-Based Nursing in the Emergency Department
A synthesis of the 6 articles reveals the following as some of the procedures that can be used to manage sepsis in the emergency department:
Sepsis bundles
One of the protocols that can greatly reduce the mortality rates associated with this condition entails sepsis bundles. Effective adherence to the recommendations made in the bundles can significantly bring down the number of deaths attributed to sepsis. The phenomenon affects the quality of nursing care. The reason is that the practitioners are involved in the collection of blood samples from patients. Among others, the samples are used to measure levels of lactate in the body. In addition, nursing practitioners are involved in the collection and management of cultures, as well as the administration of antibiotics and vasopressor therapy (Patocka et al., 2014).
According to Turi and Ah (2013), the failure to adhere to the protocols laid down in the sepsis bundles can lead to a number of negative consequences. The view by Turi and Ah (2013) is supported by Wira, Dodge, Sather, and Dziura (2014). According to Wira et al. (2014), the negative impacts include failure to identify sepsis. If the condition is not diagnosed early enough, then the initiation of sepsis bundles is delayed. The situation may lead to the death of the patient or development of a severe form of sepsis.
Protocols followed in the emergency department in relation to bundles can be improved to include thorough and routine screening for potentially infected patients. Diagnosis of severe sepsis will help in the implementation of the correct therapy (grade IC). Sepsis bundles can be made more effective by ensuring that the entire control unit works as a multidisciplinary team to promote the achievement of interventional goals (Turi & Ah, 2013). The team is made up of physicians, nurses, pharmacists, respiratory experts, and dieticians.
Educational procedures
Another protocol that can be used to manage sepsis in the emergency department involves education. New and efficient ways and methods of doing things always emerge after a period of time. As such, it is wise to ensure the protocol on education is effectively implemented (Kleinpell & Schorr, 2014). The assertion is supported by Kleinpell et al. (2013), who state that education helps the caregivers and nurses to acquaint themselves with emerging processes and protocols.
Education may be delivered in various ways and forms. Such strategies of delivery include brief learning sessions, conferences, clubs, and other forms of interaction (Sweet et al., 2010). Turi and Ah (2013) support the opinions held by Sweet et al. (2010) with regards to education as a protocol. According to Turi and Ah (2013), the educational sessions should address such issues as the assessment process, management of care, and adherence to time sensitive clusters. Members of staff should be made to understand the negative outcomes associated with the failure to implement emerging ideas and technology, especially in relation to evidence-based practice (Melnyk & Fineout-Overholt, 2010). For education to be more effective, posters, pocket cards, and treatment algorithms should be provided to the learners.
Data collection
Sepsis can also be controlled more effectively by using data collected from previous exercises carried out to manage the condition. In their article, Kleinpell et al. (2013) argue that information on standard definitions can be accessed from various sepsis campaign websites. Kleinpell and Schorr (2014) agree with this assertion by stating that improving data collection protocols may lead to the availability of real-time information on how to deal with this condition.
For example, some hospitals work on feedback from patients after the individual has already been discharged. However, the information is made available to the stakeholders after a very long time. The procedure can be improved by collecting data and feedback from patients when they are still in the hospitals. The respondents can be interviewed during feeding time or when the nursing practitioner is doing bedside rounds (Wira et al., 2014).
Discussions with the clinical team while the patient is still in the hospital are effective in developing and understanding the process of care. The strategy can be used to improve the experiences of subsequent patients. Improving data collection protocols may help in the identification of process malfunctions (Sweet et al., 2010). As such, individuals in key leadership positions, together with members of the core team, can pool resources to discuss alternative interventions (Wira et al., 2014).
Support and adjunctive therapy
Different fluids can be used to resuscitate patients with severe sepsis. The recommended first line fluid for grade IB patients is crystalloids (Patocka et al., 2014). Albumin is used when patients require a substantial amount of crystalloids. To enhance the effectiveness of this protocol, clients who have being resuscitated should be closely monitored. The aim is to evaluate their responsiveness to fluid changes and administration (Lopez-Bushnell, Demaray & Jaco, 2014). Vitals signs, such as changes in pulse pressure and stroke volume should be monitored. Administration of fluids alone may not help the patient.
Nursing professionals optimize resuscitation by monitoring the reaction of the patient to the fluids administered (Sweet et al., 2010). If no improvements are noted, the administration of fluids should be discontinued with immediate effect. Alternative methods of improving hemodynamic function should be used. Wira et al. (2014) are in agreement with this view. According to Wira et al. (2014), optimization of hemodynamics is one of the factors informing the management of sepsis patients in emergency departments.
Effective Infection Control Protocols
Patients who are critically ill are at a high risk of acquiring hospital-associated infections (Kleinpell et al., 2013). The development is associated with, among others, the use of invasive catheters and tubing during interventions. Infection control practices should be promoted to stop further contamination of patients. Such protocols include washing hands, adopting barrier precautions, and enhanced care for catheters (Patocka et al., 2014).
The view is supported by Wira et al. (2014), who recommend the application of stringent measures to control infections. Such strict protocols include oral and selective digestive decontamination. Others include sanitization with oral chlorheidine gluconate. The latter is used to reduce the risk of ventilator-associated pneumonia among ICU patients with severe sepsis (Patocka et al., 2014).
Infection prevention measures should be a prime area of focus. Contamination control protocols should be adjusted to reflect accountability and improved knowledge. Nosocomical infections should also be averted. All these hygiene measures can significantly contribute to the speedy recovery of patients suffering from sepsis. The objective is achieved by mitigating the risk of infection in health institutions.
Sepsis Protocols in the Emergency Department and Technology
The use of technology in the emergency department helps in the treatment of sepsis. In addition, it improves the diagnosis of the disease (Patocka et al., 2014). The nursing practitioner can achieve this by using automatic sepsis alert applications. The system is integrated into the patient’s electronic medical records (Sweet et al., 2010). It is based on updated vitals and analysis of records to detect signs of severe sepsis.
The effective use of this technology by nurses in the emergency department can help in controlling sepsis. For instance, if a nurse responds in time to a positive diagnosis, sepsis can be arrested at an early stage. The technology available in hospitals should be used properly to improve outcomes. To this end, nurses and other health workers must be trained on the use of the effective use of the machines. The equipment used in the emergency department should be cleaned to ensure that patients are not re-infected.
Overall Impression: How Sepsis Protocols in the Emergency Department Impact on Nursing
Improving the efficiency of sepsis protocols used in the emergency department involves changing the routine and usual ways of doing things. Complacency and failure to embrace changes is one of the reasons why procedures may not work (Kleinpell et al., 2013). Alterations and review of conventional protocols involve a long and strenuous process (Lopez-Bushnell et al., 2014). For instance, one has to bring together all the key stakeholders responsible for the execution of the improved procedure. The process is especially critical if the protocol cuts across several departments with different clinical officers. Bringing these people together may be an uphill task, especially due to the busy work schedules found in hospitals.
One way of making sure that the new intervention works is by testing on a few patients (Kleinpell & Schorr, 2014). If promising results are achieved, the procedure can be used on other patients. To make other people understand the improved protocols, education should be provided. The education should touch on assessment processes, management of care, and adherence to the sepsis bundles.
Conclusion
Medicine alone cannot be used to manage sepsis. Many factors come into play during a patient’s stay in the hospital. Key among these elements is the critical role played by nurses in the process of identification, diagnosis, and treatment of severe sepsis in the emergency department. Protocols seek to offer guidelines to the individuals involved in the treatment and care of these patients. As such, the combination of several strategies may lead to an effective workforce. Consequently, patients are provided with improved care and health services. Ultimately, the nursing practitioner is able to reduce the mortality rates associated with sepsis.
References
Czura, C., & Distlerath, L. (2010). Sepsis poses life-threatening response to infection. Medical Laboratory Observer, 42(11), 14.
Kleinpell, R., & Schorr, C. (2014). Targeting sepsis as a performance improvement metric. AACN Advanced Critical Care, 25(2), 179-186.
Kleinpell, R., Aitken, L., & Schorr, C. (2013). Implications of the new International Sepsis Guidelines for Nursing Care. American Journal of Critical Care, 22(3), 212-223.
Lopez-Bushnell, K., Demaray, W., & Jaco, C. (2014). Reducing sepsis mortality. Medical Surgical Nursing, 4, 56.
Melnyk, B., & Fineout-Overholt, E. (2010). Evidence-based practice in nursing & healthcare: A guide to best practice (2nd ed.). London: LWW.
Patocka, C., Turner, J., Xue, X., & Segal, E. (2014). Evaluation of an emergency department triage screening tool for suspected sepsis and septic shock. Journal for Healthcare Quality, 36(1), 52-61.
Sweet, D., Jaswal, D., Fu, W., Bouchard, M., Sivapalan, P., Jen, R., & Chittock, D. (2010). Effect of an emergency department sepsis protocol on the care of septic patients admitted to the intensive care unit. Canadian Journal of Emergency Medicine, 12(5), 414-420.
Turi, S., & Ah, D. (2013). Implementation of early goal-directed therapy for septic patients in the emergency department: A review of literature. Journal of Emergency Nursing, 39(1), 13-19.
Wira, C., Dodge, K., Sather, J., & Dziura, J. (2014). Meta-analysis of protocolized goal-directed hemodynamic optimization for the management of severe sepsis and septic shock in the emergency department. Western Journal of Emergency Medicine, 15(1), 51-59.