Paper Example on Sepsis: A Global Killer With High Mortality, Costly to Manage

Introduction

Sepsis is a significant cause of deaths in the world with a mortality rate of 17% for sepsis and 26% for severe sepsis, with global mortality of 5.3 million annually (Fleischmann, Scherag, Adhikari, Hartog, Tsaganos, Schlattmann, & Reinhart 2016). It costs the US government over $20 billion yearly to manage it (Paoli, 2018). Sepsis is defined as a systematic inflammatory disorder and an immune response that is caused by uncontrolled reactions to a variety of clinical infections (Napolitano, 2018). A condition is regarded as septic if a documented or suspected infection has to be proven, and as a result, a systematic response is manifested. Sepsis mostly attacks respiratory, gastrointestinal, gastrointestinal soft tissues of the body. The earliest symptoms of sepsis are fever of higher than 38oC or below 36oC, higher heartbeat rate of more than 90 heart beats per min and a breathing rate of more than 20 breaths per minute and a suspected or confirmed infection (Levy, Evans, & Rhodes 2018).

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For one to be diagnosed with severe sepsis, the must be at least two signs of sepsis, and then an organ failure whose symptoms may include; abnormal breathing, skin coloring lowered urination and unconsciousness. If not treated in time, severe sepsis quickly develops to a septic shock, which is a medical emergency. Septic shock is associated with all the symptoms of severe sepsis together with internal blood clots, which can prevent oxygen and blood from accessing vital body organs leading to organ failure and tissue gangrene. Though any infection can lead to sepsis, the most probable ones are; kidney infections, pneumonia, and infections associated with bloodstream. Sepsis can affect any person, but infants, older people, people with the low immune system as of those with HIV AIDS and patients in intensive care unit (ICU) are at higher risk of getting sepsis.

Sepsis can be survived if it is detected and treated within the shortest time possible. Nevertheless, a challenge exists in diagnosing and treatment of sepsis due to the difficulties of its definition and diagnosis. Most of the sepsis symptoms are also associated with other diseases and thus diagnosing and treating sepsis becomes difficult for nurses. To solve this, the Centre for Medicare and Medicaid Services (CMS) developed guidelines for timely diagnosis and treatment for sepsis. The instructions are aimed at reducing the mortality rate, reducing hospital stay and thus lowering the cost of care. The guidelines which were issued in 2015 offers a sepsis protocol based on a 3-hour and 6-hour bundle that requires early detection and management of sepsis within that time frame. By applying this bundle, nurses will help in reducing the deaths caused by sepsis, which are over 200,000 yearly. Timely detection and treatment of sepsis improves the patient outcome and decreases mortality (Levy, Evans, & Rhodes 2018).

There is a need to develop a guideline for diagnosing and treating sepsis cases. Guidance to sepsis care has been produced by the Surviving Sepsis Campaign (SSC) to help nurses and other clinicians for timely detection and treatment (Rhodes, Evans, Alhazzani, Levy, Antonelli, Ferrer and Dellinger, 2017). Nevertheless, over 50% of hospitals have not applied CMS protocol majorly because of the high cost associated with its implementation, and different guidelines for excluding sepsis from other diseases with similar signs. Though advancement has been made in terms of technology and instructions in the definition and protocols of addressing sepsis, it remains a challenge for advanced practice nursing, and this study aims at developing a strategy that will address sepsis protocols that are not applied.

Background and Historical Perspective of Sepsis

Sepsis is a Greek word which was first used 400 years BC, which refers to decay or decomposition of organic matter (Gul, Arslantas, Cinel, & Kumar, 2018). In the 19th century, the word was used to refer to the severe toxicity of "blood poisoning." By the late 19th century, researchers believed that mammals could be killed by microbes, where the toxic soluble substance caused as a result of infections, could cause fever graduate to cause a shock as a result of severe disease. Today, sepsis is the primary killer, with a higher mortality rate than that of cancer or HIV/AIDS (Alliance, 2018). A multidisciplinary committee developed guidelines for diagnosis and treatment of sepsis in "surviving sepsis campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016 (Rhodes et al., 2017)." The guidelines provide for an updated definition of sepsis and offer a clear, timely protocol for sepsis diagnosis and treatment.

Literature Review

Sepsis is caused by uncontrolled inflammatory as a result of infection and is the primary cause of mortality of patients in the ICU (Napolitano, 2018). It is the primary cause of death in developed countries with the highest registered emergency cases in the (Napolitano, 2018). CMS developed sepsis protocol to help in the diagnosis and treatment of sepsis and when adhered to, reduces mortality and improves patient's outcome (McClelland & Moxon, 2014). Research has proved that the sepsis mortality rate can be decreased when it is diagnosed and treated promptly within six hours as according to sepsis protocol. To achieve this guideline, nurses, who are the first point of contact with clients, need to be equipped with resources to increases patients survival. To accomplish this, nurses need to have a sepsis protocol to offer the guidelines. SSC has developed guidelines and bundles to help them arrest this condition (Rhodes et al., 2017).

The Relevance of the Practice

Due to the high rate of mortality caused by sepsis, SSC developed a guideline to standardize sepsis treatment and improve patient's outcome (Rhodes et al., 2017). The guidelines have been updated to reflect new researches, and they cover the entire sepsis protocol, from resuscitation, screening and taking care of the patient from administering antibiotics and care goals (Rhodes et al., 2017). The bundle which is categorized into three packages; one hour bundle, three-hour bundle, and six-hour bundle are all aimed at detecting sepsis as earlier as possible and arresting the situation (Napolitano, 2018). Data collected from research is in support of implementing sepsis protocol, which is developed from Surviving Sepsis Campaign guidelines to facilitate sepsis diagnosis and care and improve patient results. Application of sepsis protocol has increased patient outcome and reduced mortality for sepsis patients. Sepsis protocol is of high relevance to advanced practice nursing as it standardizes the guidelines and offers nurses an opportunity to save the lives of patients and improve patient outcomes. When sepsis protocol is applied, it will help nurses to detect sepsis patients promptly and offer them the necessary care needed to cure the condition.

Sepsis Protocol Strategies

Research has shown that patient's outcome can be improved and mortality rate reduced if sepsis is diagnosed and treated within the shortest time possible (Lehman, 2019). To achieve this strategy, various protocols and bundles have been developed, to detect and timely address septic patients to make a reduced hospital stay. Bundles help nurses to determine significant steps in diagnosing and treating severe sepsis and septic shock by changing complex guidelines to step by step behavior and practices. The goal of these bundles is to lower the mortality rate of patients and improve their outcomes, enhance the application of evidence-based patients care, and harmonize clinical practices. Concerning these two bundles were developed, which include 6-hour resuscitation and a 24-hour management bundle.

Early Recognition

Sepsis is identified through a positive test of Systematic Inflammatory Response Syndrome (SIRS), which is supported by documented or suspected infection. After identification of sepsis, it is then classified to either severe sepsis or septic shock. Sepsis needs to be tested and diagnosed within one hour from when the patient is suspected to be suffering from it. To achieve this, a high degree of care and vigilance is needed, and clinicians need to be highly trained and equipped with the necessary resources to identify and treat sepsis in time. When a patient is presented with either psychological problems or other symptoms that could be classified as SIRS, and with documented or suspected infection, such a patient should be screened for sepsis urgently. During the screening and at each stage of the test, a binary option should be made towards testing sepsis positive or negative.

A two bundle process should be applied in identifying and screening sepsis starting by detecting the presence of SIRS, and when results are positive, the patient should be tested for the severity of the sepsis. Once sepsis is identified, asepsis satisfactory risk assessment should be conducted. Once this adequate risk confirms severe sepsis or septic shock, treatment of the patient should start immediately as the other tests for blood culture among others are going through. Some criteria of SIRS is only possible with blood culture and urine output monitoring for at least two hours. The waiting time for this results may be significantly high for patients of septic shock or severe sepsis and to reduce this time for screening, point-of-care-tests (POCTs) should be conducted which can reduce this waiting time significantly and have the patients start of treatment immediately upon positive tests. This alternative test aims to ensure that sepsis patients start treatment as soon as possible as delaying treatment results in high mortality or delayed hospital time. To confirm SIRS, two of the following conditions should be available. The patient should show confusion or disturbed mental state, should test to have temperatures of higher than 38.3 degree Celsius or lower than 36 degree Celsius, a heart of more than 90 beats per minute and a respiratory rate of more than 20 breaths per minute or blood glucose of more than 7.7 mmol/L (Napolitano, 2018). Once sepsis is suspected, the first section of six steps should be applied within the first hour. When the package is used, the mortality rate is reduced significantly. The following are the six steps of sepsis six.

1. Administer oxygen to a high saturation
2. Take a blood culture before administering antibiotics but initiate antibiotics immediately.
3. Administer empirical antibiotics
4. Examine serum lactate
5. Offer intravenous fluid resuscitation
6. Start urine output measurement hourly

Surviving Sepsis Campaign (SSC) developed severe sepsis bundle, which is divided into two packages with the first one being to resuscitate the patient and the second one being for patient management. The first bundle which must be completed within six hours of the patient's positive test of severe sepsis or septic shock aims at stabilizing the patient for further monitoring and treatment. The resuscitation bundle is followed by Sepsis Management bundle, which must be offered within 24 hours of a positive test for sepsis. The first step should be to inject a small dose of steroid for patients suffering from septic shock. The bundle should be administered to patients meeting the requirements following ICU standardized protocol, and where the package is not delivered, the reasons should be documented. For patients qualifying for conducting of recombined human activated protein C (rhAPC), a dose of the same should be administered per the ICU protocol or otherwise recorded why. Glucose should be maintained at a lower level of less than 180 mg/dL. Lastly, a central aspiratory plateau pressure (IPP) should be kept at less than 30 cm H2O, where the patient is bein...