PurposeDevelop an evidenced based protocol that willallow rapid identification of sepsis and to educateand empower nurses to use the protocol tomanage patients with severe sepsis
Thousands of deaths/year 250 200 Background 150 Sepsis is a complex condition 100 that is often life-threatening. It is characterized by hematological 50 disorders and a pronounced inflammatory response to an 0 infection or injury. Sepsis accounts for 215, 00 deaths in the United States each year at a cost of more than $16 billion. Septic shock remains the most frequent cause of death in non- cardiac ICU’s Cause of deathPicard, ODonoghue, Young-Kershaw, & Russell, 2006
MethodsIdentification of patient’s with suspectedinfectionPatients > 18 yrs.Within one hour of admissionLevel 1 emergency room
Inclusion Criteria Patients > 18yrs or older with signs/symptoms of infection Meets two or more of the following for systemic inflammatory response syndrome: Temperature > 100.4 F or < 96.8 F Heart rate > 90 beats/min Respirations > 32.min or Paco2 <32 mm Hg White blood count > 12,000 cells/mm3 or < 4,000 cells/mm3
Protocol Broad Spectrum ABX 500 mL NS bolus CVP Monitor lungs Repeated q 20- sounds for tolerance <8-12 30min until CVP >8 of boluses mm HgCentral line insertion with continuous Initiate Scvo2 monitoring MAP Norepinephrine drip <65 Titrate for a MAP > 65 mm Hg Supplemental Repeat Hgb and oxygen or Scv02 2hrs after mechanical < 30% Tranfuse 1 blood transfusion ventilation unit PRBC Scvo2 Hematocrit < 70% > 30% Initiate dobutamine drip Titrate every 1 hr for Scvo2 > 70%
Results 300 patients >18yrs 24 months of data collection by trained nurses Serum lactate
Educating Staff In service programs Grand rounds Poster size sepsis protocol 24hr on call nurse
Outcomes-SuccessGoals of therapy will be met within 12hrsCentral Venous Pressure (CVP) 8-12 mm HgMean Arterial Pressure (MAP) 65-90 mm HgMixed Venous Oxyhemoglobin (Scvo2) 70%-80%Hematocrit > 30%Serum lactate < 4mmol
Barriers Educating a large staff working various shifts. Transferring patients treated by using the protocol in a timely manner. Expediting placement of central venous catheters. Equipment issues.
Summary Will obtaining serum lactate levels immediately onemergency department (ED) patients, age 18 andolder, meeting certain sepsis high-risk prognosticcriteria, reduce mortality due to immediatetreatment interventions.
Thank You! Reference Picard, K. M., ODonoghue, S. C., Young-Kershaw, D. A., & Russell, K. J. (2006). Development and implementation of a multidisciplinary sepsis protocol. Critcal Care Nurse, 26(3), 43-54. Shapire, N., Fisher, C., Donnino, M., Cataldo, L., Tang, A., Trzeciak, S., Horowitz, G., & Wolfe, K. (2010) The feasibility and accuracy of point-of-care lactate measurement in emergency department patients with suspected infection. Journal of Emergency Medicine 39(1), 89-94. Shapiro, N. I., Howell, M. D., Talmor, D., Lahey, D., Ngo, L., Buras, J., . . . Lisbon, A. (2006). Implementation and outcomes of the Multiple Urgent Sepsis Therapies (MUST) protocol. Critical Care Medicine, 34(4), 1025-1032.