Implementing Bundles from the Surviving Sepsis Campaign

Problem Statement

At times, hospitalized patients are vulnerable to other ailments, and some infections are deadly. According to Levinson, Casserly, and Levy (2011), severe sepsis is a potentially lethal disease because it progresses at an alarming rate. Sepsis does not discriminate, so anyone can contract it. Sepsis often occurs during patients’ hospitalizations; however, several groups are more susceptible such as children, babies, the elderly, and patients with chronic illnesses or weakened immune systems. In addition, patients who seek help for severe burns and physical trauma are at risk. Sepsis is a secondary issue as it is the result of the body’s immune system response to infection. As immune chemicals stream through the blood, they trigger blood clots and leaky vessels due to inflammation. In severe sepsis cases, one or more of the vital organs fail and cause patients’ deaths. Because the mortality rate ranges from 18 to 50 percent (Levinson et al., 2011, Introduction para. 1), patients often fight for their lives in the intensive care units. Incidentally, Gerber (2010) asserts that “severe sepsis kills more people than lung cancer, and more people than breast and bowel cancer combined” (p. 141).

While severe sepsis and septic shock has discouraging statistics, research suggests emergency care and critical care nurses are able to predetermine a patient’s proneness to sepsis and alert physicians, so they can provide early and aggressive care in order to eliminate advancement to the later deadly stages. Levinson et al. (2011) emphasizes that we have an overwhelming need to find methods for quick diagnosis and preventative measures in order to lessen the mortality rate (Introduction para. 1) In addition, hospitals around the globe should embrace the Surviving Sepsis Campaign and assist in collecting data in order to aid further research. Essentially, it has been found that using the Surviving Sepsis Campaign’s bundles allow “early recognition and treatment of sepsis [that] is crucial for clinicians to improve outcomes and decrease sepsis-related morality” (Kleinpell et al., 2013, p. 213). Initially, severe sepsis and septic shock are “characterized by components of hypovolemic, cardiogenic, and distributive shock” (Levinson et al., 2011, Methods of Reducing Morality para. 1). When nurses notice the characteristics, they can potentially save lives. The Surviving Sepsis Campaign offers bundles to hospitals as guides. Furthermore, the bundles are based on evidence-based practice guidelines. In addition, the campaign strategizes ways to improve hospital care in under-resourced areas. 

Principally, a nursing diagnosis helps to supplement or provide a direction for the physician’s care. While nurses cannot diagnose a patient in a traditional way, our initial assessment is of upmost importance. An educational awareness program led by critical care and emergency care nurses for other nurses would emphasize that sepsis can rapidly progress to severe sepsis to septic shock in a mere 24 hours. At the same time, an awareness program will encourage critical care and emergency care nurses to follow the bundles created by the Surviving Sepsis Campaign.

Instructional Setting

Nurses are caretakers and educators, so it is our obligation to provide valuable information to our fellow nurses. The instructional setting will be in a hospital conference room. While defining diagnosis through point of care testing and treatment of sepsis requires a collective team effort including “physicians, nurses, pharmacy, respiratory, dieticians, and administrators” (Kleinpell et al. 2013, p. 214), the main objective of the learning experience will provide an opportunity for an emergency and critical care nurse to present the Surviving Sepsis Campaign. 

As an educator, a nurse will inform her peers of newly established guidelines. According to Kleinpell et al. (2013), surviving sepsis bundles include “(1) recommendations directly targeting the management of severe sepsis, (2) recommendations targeting high-priority general care considerations, and (3) pediatric considerations” (p. 214). Essentially, bundles provide a definitive guide in when and what nursing staff should do when certain criteria is established. The learners will understand that adherence to the bundles has been established to be effective in prevention of severe sepsis or septic shock. 

As an example of a bundle, the American Association of Critical Nurse’s (AACN) Practice Alert (2010) suggests nurses alert physicians if their patients show two or more of the following systematic inflammatory response syndrome (SIRS) criteria: 

• The patient’s temperature is greater than 101F or is less than 96.8F

• The patient’s heart rate is greater than 90 beats per minute

• The patient’s respiratory rate is greater or equal to 20 breaths per minute of PaCO2  is less than or equal to 32 mmHg

• The patient’s white blood cell count is greater than or equal to 12,000/mm3 or less than or equal to 4,000/mm3 or a left shift in the immaturation of granulocytes (bands) is greater than 10%

• AND “at least one of the following indicators of tissue hypoperfusion or sepsis related acute organ dysfunction” (2010): 

• Acute altered mental status

• Systolic blood pressure < 90mmHg or mean arterial < 70mmHg or a spontaneous bacterial peritonitis (SBP)decrease of 40mmHg

• Blood glucose > 140 mg/dL in patients without diabetes

• Arterial hypoxemia (PaO2/FiO2 < 300)

• Acute oliguria (< 0.5 ml/kg per hour for at least two hours)

• Creatinine increases > 0.5 mg/dL above baseline

• Coagulation abnormalities (INR > 1.5 or a PTT > 60 seconds

• Ileus 

• Thrombocytopenia (platet count, < 100,000 L-1)

• Hyperbilirubinemia (plasma total bilirubin > 2mg/dL) Lactate > 2 mmol/L

As problem solvers, nurses will commit to “nurse driven quality improvement projects to target sepsis…and implement the new guidelines, targeting multidisciplinary and multispecialty involvement” (Kleinpell et al. 2013, p. 214). Because of different shift times, the learners will understand that they can access any material regarding the Surviving Sepsis Campaign via their website. The website allows others to attend web-conferences, so it is both convenient and necessary. In addition, learners will be provided with the Surviving Sepsis Campaign Declaration Letter to accentuate the necessary commitment. 

Severe sepsis and septic shock claim too many lives. As care providers, nurses should add to and implement evidence-based research guidelines to decrease the amount of severe sepsis and septic shock mortalities. 

Research Questions

1. What are the challenges involving pediatric sepsis? 

2. What is the best way to encourage statewide support of the Surviving Sepsis Campaign?

3. How can our unit participate in the campaign using data collection? 

4. What are the challenges in treating sepsis in under-resourced hospitals?

References

AACN Practice Alert. (2010, April). Severe sepsis: Initial recognition and resuscitation [PDF]. American Association of Critical Care Nurses.

Gerber, K. (2010). Surviving sepsis: A trust-wide approach. A multi-disciplinary team approach to implementing evidence-based guidelines. Nursing in Critical Care, 15(3), 141-151. doi: 10.1111/j.1478-5153.2009.00378.x

Kleinpell, R., Aitken, L., & Achorr, C. A. (2013). Implications of the new international sepsis guidelines for nursing care. American Journal Of Critical Care, 22(3), 212-222. doi: 10.4037/ajcc2013158

Levinson, A. T., Casserly, B. P., & Levy, M. M. (2011). Reducing mortality in severe sepsis and septic shock. Seminars in Respiratory and Critical Care Medicine, 32(2).

Society of Critical Care Medicine, & European Society of Intensive Care Medicine. (n.d.). About the Surviving Sepsis Campaign. Surviving Sepsis Campaign. Retrieved from http://www.survivingsepsis.org/About-SSC/Pages/default.aspx