In Emergency Department nurses, does nursing education improve recognition
of signs and symptoms of sepsis and knowledge of a hospital sepsis protocol?
Lauren Waltman, SN & Frances Zondlo, SN
Introduction/Background
- Sepsis/Septic Shock (SIRS with infection)
- 750,000 Americans affected annually by a form
of sepsis.
- Sepsis hospitalizations more than doubled from
2000 to 2008.
- Rivers et al. (2001) were pioneers for early-goal
directed therapy.
- Prior to admission to ICU, patients with
undiagnosed sepsis present to ED where prompt
identification needs to occur.
- In most cases, nurses are the first to interact with
these patients and have the potential to identify
sepsis.
Sepsis: The Silent Killer
* Se p s i s a c c o u n t s f o r
5 0 0 , 0 0 0 ED v i si t s
a n n u a l l y i n t h e US
* Se p si s k i l l s m o r e t h a n
b r e a st c a n c e r , p r o st a t e
c a n c e r , a n d AI DS
com b i n ed .
Did you know?
SIRS CRITERIA
Methods
- Study conducted at Pinnacle Health Harrisburg
Hospital Emergency Department
- Twenty nurses provided with pre-quiz,
educational flyer, and post-quiz
- Quizzes surveyed the following areas: nurses’
knowledge of sepsis, knowledge of hospital
protocol for sepsis, and self-confidence in
recognition and treatment of sepsis
- Nurses were excluded if they were unable or
unwilling to participate in the educational phase
or the postquiz
- Educational materials were critiqued by
participating nurses via postquiz addendum
SIRS=Systemic Inflammatory
Response Syndrome
- Temperature > 38.3 and <36.0
- WBC count >12 and <4
- HR >90 bpm
- Respirations >20 breaths/min
- Significant edema
- PaCO2 < 32 mmHg
- Altered mental status
- Non diabetic glucose >120
- Classification of Sepsis can only be established when:
- patient meets 2 SIRS criteria
- patient has suspected or confirmed infection
- Ideally, blood cultures should be obtained prior to antibiotic
administration
- Positive Serum lactate screen is used as a diagnostic test for
sepsis because it is associated with mortality.
- Lactate levels >2 mmoL/L are considered
hyperlactatemia
- Classification of Septic Shock can only be established when:
- patient meets criteria for sepsis
- patient has refractory hypotension (low BP despite
fluid resuscitation)
Please refer to back side of this flyer for
Pinnacle Health’s sepsis protocol!
Results/Discussion
- Pre-quiz:
- 95% of nurses reported confidence in their
abilities to recognize sepsis
- 75% of nurses failed to recognize key signs and
symptoms
- Unable to differentiate between local infection
and potential sepsis
- Unaware of fluid resuscitation protocol
- Post-quiz:
- 100% of nurses correctly identified key signs
and symptoms of sepsis
- Improvement in recognition of potential sepsis
versus local infection in Case Study
- Improvement in awareness of fluid bolus
protocol
- Limitations
Conclusion
- Ongoing education on identification of sepsis and
protocols is recommended for ED nurses and staff
- Improving communication amongst ED and ICU
- Further research needed of nurses’ role in sepsis
identification and treatment
Special Recognition to the Managers and Staff of Pinnacle Health Harrisburg Hospital ED
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