Topic and the Need for Improvement
Sepsis is defined as an inflammatory response that comes as a result of an infection. Research has shown that sepsis has a high in-hospital mortality rate. According to Gauer (2013), the mortality rate ranges between 25% and 30%. Hospitals must create a platform for the early recognition of sepsis in patients. Recognizing the sepsis at the early stage is associated with improved patient outcomes and better satisfaction levels. As illustrated by Amland & Hahn-Cover (2016), "Early recognition and treatment can reverse the inflammatory response, with evidence of improved patient outcomes." Gauer (2013) further indicates that recognition and goal-directed therapy within the first 6 hours can significantly reduce in-hospital mortality. Other than satisfaction and improved outcomes, the early detection of sepsis can assist in improving the lives of the patients.
State How Patients’ Are Affected By the Issue
Gauer (2013) defines sepsis as an inflammatory disorder with life-threatening implications characterized by the immune system’s response to an infection. The disease affects about 750,000 persons per year, with a prevalence rate of about three cases in every 1000 persons (Gauer, 2013). The symptoms presented in a patient can significantly change from one person to the other, depending on the etiology of the disease. The main sites of infection include the genitourinary, respiratory, integumentary, and gastrointestinal systems. The soft tissues of the body are also affected. The first symptom associated with sepsis is fever. The fever then translates to pneumonia during the advanced stages of the sepsis.
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Bacteria are primary causative agents for sepsis. In some patients, viral, fungal, and parasitic infections can also contribute to the infection. As illustrated by Amland & Hahn-Cover (2016), "When treatment is delayed, sepsis can rapidly advance to septic shock, multiple organ dysfunction syndromes (MODS), and death" (p.495). Survivors of sepsis tend to have a reduced quality of life. Persons aged 65 years and above have a higher risk of acquiring sepsis and the adverse death that results from it, including death. Other additional risks that increase a person's predisposition to the illness include immunosuppression, malnutrition, chronic illness, and recent surgery, among others (Gauer, 2013).
In some instances, fever might not be experienced in certain groups of patients, especially the elderly. Instead, these patients might experience sepsis-induced hypothermia (Gauer, 2013). Other patients that might experience sepsis-induced hypothermia include the ones with uremia and individuals with a history of chronic alcohol abuse. Debilitated patients might also fail to register a fever that is commonly associated with sepsis. Research by Gauer (2013) further illustrates that up to 40% of the patients can experience hypotension.
Proposal
Resolving sepsis should be based on the early detection of the symptoms. According to Gauer (2013), early detection should begin as early within the first six hours following the infection. The initial steps taken should include respiratory stabilization and the provision of supplemental oxygen. Mechanical ventilation should be followed immediately in cases where supplemental oxygen does not improve the process of oxygenation. After stabilization, the patient should be placed in a through a process of fluid resuscitation, antibiotic treatment, vasopressor therapy, and the identification and control of infection (Gauer, 2013). Some care facilities engage in a management process that takes as short as three hours.
As described by Borrelli, Koch, Sterk, Lovett and Rech, (2018), "Early intervention includes a bundle to be completed within 3 hours of recognition of severe sepsis or septic shock” (p.1). Within these three hours, a host of strategies should be taken, including measuring the serum lactate concentration and fluid resuscitation to prevent the adversities that might arise from hypotension. The authors further emphasize the importance of quick administration of antibacterial treatment to aid in dealing with the microbes responsible for sepsis. Research shows that prompt administration of antibiotics coupled with intravenous fluids is a crucial step in the management of sepsis. The authors say, “Early detection of sepsis with timely, appropriate interventions increases the likelihood of survival for patients with sepsis” (Kim & Park, 2019) Both World Health Assembly and World Health Organization assert that sepsis should be regarded as a medical emergency (Kim & Park, 2019).
The use of a clinical decision system (CDS) can also guide the process of decision-making during the early treatment process. As illustrated by Amland & Hahn-Cover (2016), “A clinical decision support system (CDS) offers a systematic application of health-related knowledge and analysis of available data” (p.494). Healthcare professionals using the CDS have an opportunity to achieve the key performance goals of the treatment process.
Improvement of Patient Care
The literature review has shown that early intervention can improve patient outcome and their level of satisfaction. As illustrated by Borrelli (2018), early diagnosis and treatment prevent the patient from reaching the level of sepsis shock, which has more severe implications. Treatment reduced the mortality rates among the patients and ensures that these individuals regain their condition from the debilitating state that the disease places them. Patient satisfaction comes about when the patients are fully appeased by the care strategies taken (Hahn-Cover, 2016). Early identification and treatment show that the healthcare system is cognizant of the needs of the clients.
Evaluation of Proposed Change
The proposed change can be measured and evaluated using several methods. The first area of focus should be based on the patient's level of satisfaction. Satisfaction among the patients treated will focus on receiving feedback through questionnaires, interviews, and surveys, among others. Also, emphasis should be placed on observation. The clinicians handling the patient can observe the progress of the patient following the early recognition of the sepsis. Emphasis must also be placed on the health care workers attending to the patient. Through appraisals, health workers can give their take on the feasibility of the process and whether they can pursue it on a long-term perspective.
References
Amland, R. C., & Hahn-Cover, K. E. (2016). Clinical decision support for early recognition of sepsis. American Journal of Medical Quality, 31(2), 103-110.
Borrelli, G., Koch, E., Sterk, E., Lovett, S., & Rech, M. A. (2019). Early recognition of sepsis through emergency medical services pre-hospital screening. The American Journal of Emergency Medicine, 37(8), 1428-1432.
Gauer, R. (2013). Early recognition and management of sepsis in adults: the first six hours. American Family Physician, 88(1), 44-53.
Kim, H. I., & Park, S. (2019). Sepsis: Early recognition and optimized treatment. Tuberculosis and Respiratory Diseases, 82(1), 6-14.
