Author: Nicole Kupchik, MN, RN, CCNS, CCRN-K, PCCN-CMC
There are a LOT of health awareness days out there. September is focused on raising awareness on sepsis, a life-threatening health issue. There are four ways you can contribute to increasing sepsis awareness and outcomes:
- Educate a friend or colleague on what sepsis IS
- Communicate to providers early and often if you think your patient has sepsis
- Increase your knowledge – the signs and current treatment modalities
- Ensure your patient gets the right treatment, right amount at the right time
Sepsis kills. It’s the leading cause of death in U.S. hospitals and costs hospitals A LOT of money to treat (to the tune of over $20 billion per year). In case you need a refresher, sepsis is the body’s dangerous and over-reactive response to an infection that can lead to organ dysfunction. Instead of fighting off the infection, the body begins attacking itself, which can lead to tissue damage, organ failure and death. This is bad news all around!
Now, let’s talk about the patient knowledge gap. It’s likely that half of your patients have no idea about sepsis; only 58% of Americans have even heard of it. They’re not going to be on the lookout for signs, so they need your help. As nurses, we’re in the perfect position to detect the onset of sepsis and reduce its impact. Make sure you know all of sepsis’ warning signs, ways to reduce risks and treatment solutions. By staying up to date, you are giving your patients the best chance for recovery—or better yet, preventing it from happening at all (cue: wash your hands!).
We can also make a difference system wide. Ten years ago, in my experience as a Clinical Nurse Specialist, I led a team and founded a hospital-wide Sepsis Program after noticing the need to improve outcomes for septic patients. Since that time, I’ve come across a few lesser-known but critically important components to sepsis care. Do you incorporate the below at your hospital, or is it time to ask for a protocol update?
IV Fluid Balance Plays a Bigger Role Than You Think
It’s a common misconception that all patients need the same amount of IV fluid. Under-resuscitation with IV fluids can be detrimental and cause rapid circulatory collapse. However, over-resuscitation can be equally harmful! When patients get too much fluid in sepsis, a lot of the fluid causes edema which can lead to acute respiratory distress syndrome (ARDS) and acute kidney injury. This leads to poor long-term outcomes. Just like any other drug, IV fluids can be harmful if not dosed correctly.
We need to give just enough fluid and not a drop more! Too much or too little fluid harms patients.
New Technology Helps Reduce the Risk and Challenges of Sepsis
Monitoring a patient’s response to IV fluid is challenging, since current assessment methods like heart rate and blood pressure don’t tell us what the patient’s heart is doing in response to the fluid. Non-invasive technology that measures stroke volume can provide instant responsiveness of the heart when used with the passive leg raise (PLR) test or by giving a quick small fluid bolus, taking out the guesswork.
For example, let’s say your patient is hypotensive with a BP of 84/42 and you are trying to decide between giving fluids or starting (or increasing) a vasopressor. With stroke volume technology, you can get a baseline to see what volume of blood the heart is pumping. Then, challenge the heart by laying the patient flat and passively lifting their legs, or give a 250 cc fluid bolus as quickly as possible. If the stroke volume increases by 10% or more, they likely will be responsive to fluid. If the increase isn’t at least 10%, start or increase a vasopressor. It’s that easy!
Don’t take my word for it. One study out of the University of Kansas Medical Center used stroke volume and dynamic assessments to understand how stroke volume-guided fluid resuscitation in septic patients impacts outcomes. The researchers found that getting a patient’s IV fluid management right decreased hospital ICU length of stay by 2.89 days, reduced the need for mechanical ventilation by 49%, reduced the need for dialysis and demonstrated an average cost avoidance by over $14,000 per patient!
Part of my job is educating other nurses and clinicians about the importance of administering accurate IV fluid amounts and reminding them that every patient has unique fluid needs. Fluid monitoring technology has been a great support in showing them what this means.
See How Your Hospital Stacks Up
The quality of a hospital’s sepsis care is no longer private information. As of July 25, data on the percentage of patients who received appropriate care for severe sepsis and septic shock are available to the public via Medicare’s Hospital Compare website. I’m betting many are keeping a close eye on their scores and looking for ways to improve.
We can’t cure sepsis, but we can stay vigilant and speak up. We must stay up to date on the latest in sepsis care and raise our hands with suggestions for improvement. Sepsis Awareness Month is the perfect time to review the latest research on sepsis, be an active participant in hospital-wide performance improvement programs and research the newest technology in sepsis care. You can make a difference!
Nicole Kupchik MN, RN, CCNS, CCRN, PCCN-CMC, has been a Critical Care Clinical RN for over 25 years. She is an author and independent Clinical Nurse Specialist. You can contact her at in**@ni*********************.com.