Surely we’ve all heard the word sepsis before. If you’re new to the nursing game, get ready to hear it talked about A LOT. The trouble is, it doesn’t seem to be explained very well to us as students – we just seem to be told it is very important to look out for and very dangerous. But are we really confident in what to spot? Student editor Alisha Poole explains…
Know what it is…
First it is important to be aware of the severity of sepsis, the overall death rate for patients admitted with sepsis is 35% - that’s around 5 times higher than for heart attack or a stroke! Its responsible for around 37000 deaths per year in the UK and around 100000 hospital admissions.
Sepsis starts when a body has a dysregulated response to an infection which manifests as two or more systemic inflammatory response syndrome (SIRS) criteria:
• New onset confusion or altered mental state
• Temperature >38.3oc or <36oc
• Heart rate >90bpm
• Respiratory rate >20 breaths per minute
• Blood glucose >7.7mmol/l (in absence of known diabetes)
• White cell count >12
This, with no evidence of organ dysfunction is known as ‘uncomplicated sepsis’. If these two or more SIRS criteria are accompanied by organ dysfunction, it is known as ‘severe sepsis’. If there is hypoperfusion (decreased blood flow through an organ) which is resistant to fluid therapy, it is known as ‘septic shock’.
Know what to look for…
The bottom line is that as students we really do have the luxury of time while we are on placement, even though it may not always feel that way.
We have more time to spend with our patients, and we have our mentors who are there to help answer our questions. With that in mind it is important that you pay particular attention to the vital signs when you are taking them, I know they lose their shine after the first year or so when you get excited by learning other, newer skills.
But make sure you take them regularly, that way noticing abnormal signs will become more of a second nature.
NICE guidelines state that ‘physiological observations should be recorded and acted upon by staff who have been trained to undertake these procedures and understand their clinical relevance’ so make sure you understand your vitals!
It is also a good idea to start learning some of the blood test results early on in your course – I know I wish I had! It’s really handy to be able to look at a result (for example lactate levels which are important in sepsis) and know if it is abnormal or not.
As we all know nurses are the frontline of care alongside the health care assistants – this means that it is up to us to be up to scratch with recognising a deteriorating patient.
Sometimes nursing staff can be rushed off their feet, particularly if it is an acute ward setting, this can lead to abnormal signs being missed. This is where we step in as students, we can be that back up, using that wonderful luxury of time that we have on placement to get to know our patients and speak on their behalf to say “actually, this patients EWS score has been at 0 all day and now it’s a 4, we need to start the sepsis pathway.”
Know what to do…
So, you have identified your patient has abnormal vital signs. What now? Well, first things first inform your mentor.
Then begin the sepsis screen, to identify what kind of sepsis you are dealing with – if severe sepsis or septic shock is suspected, the sepsis six bundle should be started immediately.
There are a number of different basic care bundles in use for the immediate management of patients with sepsis in the UK. The most widely used is the sepsis six, which has been shown to reduce mortality significantly when applied within the first hour.
1. High flow oxygen
2. Blood cultures
3. Intravenous antibiotics
4. Fluid resuscitation
5. Check haemoglobin and serial lactates
6. Hourly urine output measurement
Being familiar with the documentation required when starting the sepsis pathway is also important. Make sure you are aware of where it is kept on the ward and know how to fill it in.
It can sound quite scary but it will become second nature to you as you go further in your career. It is important for you to ensure you are vigilant in keeping check on sepsis, practice gold standard care and you will inspire others to do the same!