background and rationale

Sepsis is the human body’s extreme response to an infection and without prompt treatment often rapidly leads to tissue damage, organ failure, and death. According to the latest data from the CDC, in the United States, more than 1.7 million people develop sepsis, and at least 270,000 die annually. Approximately one1 in three3 patients who die in a hospital have sepsis. This does not include the patients that have been discharged to hospice (CDC 2019), or other facilities. The creation of checklists and protocols are to be utilized for quicker reaction time to the presentation of a life-threatening illness.

Asepsis bundle refers to  a short, straightforward set of evidence-based practices intended to improve  outcomes with patients presenting with sepsis. Bundles were developed by the Institute for Healthcare Improvement to help health care providers more reliably deliver the best possible care for patients in a timely manner. (CDC 2019).

The change in mortality from 2008 without the use of bundles and 2009 after the initiation of bundles in Community-Acquired Pneumonia (CAP) is demonstrated by  Hartmann, Heppner, Popp, Lad, & Christ 2014. In 2008 the mortality was  14.3% to 2009 11.3%.  Secondarily this study found 80 years and older category. This category was not impacted by the use of bundles during this study.  The purpose of this paper is to evaluate the use of sepsis bundles in practice.

PICO Question

Patients 65 years and older presenting to the emergency department with signs and symptoms of Sepsis, what is the effect of using Sepsis Bundles on the 30 days and 90 day survival compared with not using the Sepsis Bundles?

Search Strategies

The search was limited to all, the English language articles and publications. The  study was also limited to patients of more than sixty-five years of age with articles being published from the year 2015 to 2019. The studies used were all qualitative studies that were published along that period. For the exclusion criteria, all the articles that were not written in English were excluded. Also, the articles that included patients that are below the age of sixty-five years of age are not included. The articles that were published before the year 2015.the rationale behind the limits is that is used is that the articles have to give the latest information about symptoms and tests for survival sepsis and the effects of sepsis bundles. As well, the articles have to be in English to include the information that is clear and understandable.

The search is also performed in the following manner: two articles from CINAHL Complete, one article Clinical Key, two articles from DynaMed Plus and two articles from PubMed. I also search for the CDC and the Minnesota Health Department.  Through doing the search, the total of articles that showed was 35 which had to be filtered to meet all the limits that have been set.  The articles used are all referenced according to the guidelines of the APA. The research was done through the following keywords: Mortality, Sepsis, Surviving Sepsis Campaign, Elderly, Emergency Department Sepsis rates, and Elderly Sepsis Infection. Apart from this, there are other terms used such as recent articles. Several clinical practices focus on systematic reviews. This study used the review to help with the highest evidence levels. A Cochrane Systematic Review database was used in the search for these articles. From the start of the search, the search term used was “Use of Sepsis bundles,” ” Surviving sepsis” as general terms. These terms gave one hundred and forty-three results. From this research, I found that the search was all related to the surviving sepsis and the continuous use of the sepsis. There are the other generalized terms that gave results such as “the human body response” extreme response” ” infection treatment” “tissue damage,” “organ failure,”  it was imperative to use the articles and research works that were sepsis-related. The filter review that was used after the process gave three articles that had the terms related to all the “Use of Sepsis bundles,” “Surviving sepsis” and “infection treatment.”

Apart from these, there were several other articles related to the topic of discussion as the researcher continued in the search.  However, there were other searches that did not yield the results

Review of  matrix

Summary of findings

From this review, it is evident that sepsis is a complex syndrome and comes in many spectrum severities. It is also true that it is on \e if the conditions that cause the most common causes of death in the intensive and critical care units. The surviving epis campaign was initiated the year 2004 just because of this concern that was raised by the people. Care bundles are evidence-based interventions that are used in the management and diagnosis of the patients suffering from this illness.  The damage that it causes the organs is what makes it a tricky and more challenging prospect to manage and to handle. The very top infectious components in the body that it affects are the uni\rinanry tissues and other tissues such as the skin and the pulmonary tissue. The most commonly affected patients are the patients that are above the age of 65 years. There is also the lack of the mortality change that was found in the patients of more than 80 years of age.

Substantial evidence show that the implementation of the survival sepsis bundles leads to improvement in the outcome of the patients. The severe septic hock is seen to reduce by a massive 20 percent according to the research. There were similar results that have been observed by the researchers that are focused on the evidence-based practice. Thee rse\ults have been better ever since there was the first implementation of the method more than seven years ago.  The quality if the improvement that is seen in the implementation is a true testament of the reduced hospital cost hat in turns helps the economy. The article by Hortmann, Heppner, Popp,  Lad, and  Christ, 2014).taes that there is a significant change in mortality when the Sepsis Bundles and checklists are utilized. Compliance is also a key factor in the rate of mortality. There has to be better than 19% compliance by the hospitals. These facts have been supported b the research that states that The numbers of comorbidities had a negative effect on many people. The research by Hall, Williams, DeFrances, and Golosinskiy, 2011) states that the number of hospitals compliant with the use of the bundles was found to be around 19%. Other studies showed that the implementation of the bundles from 2008 to 2009 provided the positive outcome of lower mortality in 2009, 11.3% vs. 14.3% in 2008.

Recommendation

The following recommendations can be made on this project; the first is that there should be an administration of the broader spectrum antibiotics for this implementation. The rationale behind this is that there is early adherence to the antibiotic stewardship that gives high care quality. Their e is a separate category of patients with significantly higher severity of sepsis and mortality. This has to be taken into consideration. These are the patients that are over 80 years old and the number of comorbidities impacts this outcome. It is also recommended that there should be knowledge of the comorbidities which are found to be, hypotension, diabetes, and COPD. Apart from this, there is renal insufficiency. Recognition of the signs and symptoms takes place when the nurses interact with various patients within a wide range of settings. These include the varieties in emergency departments, the medical or the surgical care units.

Promoting education is the other recommendation.  The proposal for the sepsis education program which will be crucial in promoting the guidance for sepsis screening procedures and the process of communicating the various finding is crucial. This will allow the nurses to keep up-to-date through understanding the reasons for providing motivations for different forms of treatment to the patients suffering sepsis. Educational resources are used for promoting the various education on the Surviving Sepsis Campaign (SSC) and the  hour-1 bundle.

References

Hall, M. J., Williams, S. N., DeFrances, C. J., & Golosinskiy, A. (2011). Inpatient care for septicemia or sepsis: a challenge for patients and hospitals.

Weant, K. A., Hirschy, R., Sterk, E., Dobersztyn, R., & Rech, M. A. (2018). Time Spent in the Emergency Department and Outcomes in Patients With Severe Sepsis and Septic Shock. Advanced emergency nursing journal, 40(2), 94-103.

Hortmann, M., Heppner, H. J., Popp, S., Lad, T., & Christ, M. (2014). Reduction of mortality in community-acquired pneumonia after implementing standardized care bundles in the emergency department. European Journal of Emergency Medicine, 21(6), 429-435.

Kim, M., Watase, T., Jablonowski, K. D., Gatewood, M. O., & Henning, D. J. (2017). A Sepsis-related Diagnosis Impacts Interventions and Predicts Outcomes for Emergency Patients with Severe Sepsis. Western Journal of Emergency Medicine, 18(6), 1098.

Levy, M. M., Rhodes, A., Evans, L. E., Antonelli, M., Bailey, H., Kesecioglu, J., … & Kleinpell, R. M. (2019). COUNTERPOINT: Should the Surviving Sepsis Campaign Guidelines Be Retired? No. Chest, 155(1), 14-17.

Levy, M. M., Evans, L. E., & Rhodes, A. (2018). The surviving sepsis campaign bundle: 2018 update. Intensive care medicine, 44(6), 925-928.

Prunella, L., Westra, B. L., Yadav, P., Hoff, A., Steinbach, M., Kumar, V., … & Simon, G. (2018). Delay within the 3-hour surviving sepsis campaign guideline on mortality for patients with severe sepsis and septic shock. Critical care medicine, 46(4), 500-505.

Rhodes, A., Phillips, G., Beale, R., Cecconi, M., Chiche, J. D., De Backer, D., … & Girardis, M. (2015). The surviving sepsis campaign bundles and outcome: results from the international multicentre prevalence study on sepsis (the IMPreSS study). Intensive care medicine, 41(9), 1620-1628.

Mukherjee, V., & Evans, L. (2017). Implementation of the surviving sepsis campaign guidelines. Current opinion in critical care, 23(5), 412-416.

CDC. (n.d). Protect your Patients from Sepsis. Retrieved from https://www.cdc.gov/sepsis/pdfs/hcp/HCP_infographic_protect-your-patients-from-sepsis-P.pdf