Interventions by nurses cut sepsis deaths by 30%

ED nurses at Carolinas Medical Center in Charlotte, NC, completely revamped the way they care for sepsis patients, which resulted in a 30% decrease in mortality.

ED nurses use a modified version of an early goal-directed therapy protocol, which gives more aggressive treatment to sepsis patients.

These steps are taken by ED nurses:

  • Point-of-care lab testing is done at triage by emergency nurses, which gives the patient's lactate level. "This assists with identifying sepsis," says Anne Focht, RN, MSN, who participated in the sepsis project as a clinical nurse specialist in the case management department. "Blood cultures are also drawn, and appropriate antibiotics are initiated if sepsis is suspected."
  • If the patient meets systemic inflammatory response syndrome criteria, has a low blood pressure that doesn't respond to fluid boluses, and/or a lactate level equal to or greater than 4, a "Code Sepsis" is paged.
  • This triggers the response team, which consists of an ED physician, an ED nurse, a respiratory therapist, and a medical intensive care unit (MICU) nurse. The "code sepsis" cart is brought to the patient's bedside and set up for central venous oxygen saturation ScvO2 central line insertion.

"This allows the nurse and physician to monitor CVP [central venous pressure] and ScvO2, which guides further treatment and interventions as needed," says Focht.

Once the patient is stabilized and a MICU bed is available, the patient is transferred out of the ED.

"The protocol was somewhat challenging for ED nurses initially, as it required learning how to set up monitoring for CVP and ScvO2," says Focht.

The two biggest challenges for ED nurses were documentation of CVP and ScvO2, and to meet the six-hour time frame from ED presentation. To improve both of those, ED nurses received education and passed a competency checklist, which is now part of their annual competency. [Editor's note: The ED's competency evaluation form is included.] "The ED nursing staff also received support from the MICU nurse who responds to the codes and assists with set-up as needed," she says. "'Code Sepsis' has become a routine protocol in the ED, which the staff is very comfortable with initiating."

Source

To obtain a copy of the severe sepsis and septic shock flowcharts, contact:

  • Anne Focht, RN, MSN, Clinical Practice Manager, Pulmonary and Critical Care Medicine, Carolinas Medical Center, Charlotte, NC. E-mail: Anne.Focht@carolinashealthcare.org.