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Per our infection control nurse, one area in which my hospital lacks is with patients diagnosed with sepsis. I have yet to get ahold of the numbers which I will have later this week, but per Melissa, these numbers are not great and could be improved. She believes and even from working as a bedside nurse in the Intensive Care Unit (ICU), I agree with her that we are lacking in the department of handoff communication between nurses. Report from the emergency room to the floors, or from the floors to a higher level of care (I.e. ICU’s, Cardiac ICU’s, ICU step downs or telemetry), there is a lack of effective communication between nurses.
We all are aware of a sepsis bundle as it was drilled into our minds during our nursing programs and very well followed us into our careers. Whether you work medical-surgical, telemetry, critical care, mother/baby, labor and deivery, pediatrics, etc., we will always have patients of all ages who can have sepsis. Although the sepsis bundle is quite straightforward, communicating that is not always easy. Many times, nurses are not thorough in their reports of interventions and cares already provided, fail to notify the receiving nurse of sepsis protocol interventions that were canceled by physicians although this is not allowed in my facility or miss handing off important parts of report. By discontinuing interventions I am talking about a physician saying it is not necessary to achieve repeat lactates, administer fluid boluses, more than one sets of blood cultures, etc. Main things you would do during a sepsis bundle. It is now the nurses responsibility, per protocol, to reorder any interventions that a physician has canceled despite the discontinuation.
Our hospital is beginning to implement a paper form, strictly for nursing to complete and then hand into our quality department for review. We are calling this the “Sepsis Handoff Tool”. It is a form that has the nurse fill out the time and date of when severe sepsis was recognized and what systemic inflammatory response syndromes (SIRS) were identified. It also requires the hospitalist notified three sets of vital signs to be noted. The form also has two boxes, one with a three hour sepsis bundle power plan and the other with a six hour sepsis bundle power plan; all which much be checked off with no exceptions. Then registered nurse and physician both must sign the paper and send to the quality department. With this new implemenation, infection control will then perform a study on whether this new tool increased patient outcomes or not.
As nurses, there are many implications to our job. WIth sepsis and nursing in general, we are expected to be on top of our patients, their cares and interventions. We are responsible for making sure our patients are receiving all of the treatments they have ordered and that they are appropriate. WIth sepsis, a patients condition can rapidly deteriorate. We are a part of the team that attempts to prevent this from occuring, which means implementing our protocols and policies to the fullest extent. This handoff tool has the potential for nurse to nurse and nurse to phyisicians to both be on the same page and aware of patient care. The second implication for nurses would be that we are here to help our patients. As nurses, we do what we do to help those who are sick. Accurately implementing interventions that have been proven to decrease morbidity related to sepsis when performed together are interventions that we should be doing. Having a form that helps nurses reduce time wasted in determining what has and has not been done is very beneficial as we can go right ahead to implement appropriate interventions that are left.