Sepsis presents challenges in the hospital setting that places medical-surgical nurses on the frontlines to identify and respond to this medical emergency. Four registered nurses with extensive sepsis backgrounds met recently to share their insights and experiences on the complexities of “solving sepsis” in the Medical-Surgical environment. Here are some highlights from their collaborative dialog.
Sepsis Challenges in the Medical-Surgical Setting
“Sepsis is sneaky,” began Sharon Mladucky, a sepsis clinical specialist. “Symptoms can mask themselves as other types of diagnoses in the early stages.”
“The biggest challenge we have is identification,” agreed Maureen Holtz, a hospital-based sepsis coordinator. “Maybe it's an elderly person, or someone who had a stroke in the past. People don't necessarily identify sepsis until it’s staring them in the face.”
Kimberly Holms, a medical-surgical nurse, pointed out how busy floor nurses are--especially when dealing with an influx of new patients. “The nurses may not identify the signs of sepsis, or possibly assume it's already been picked up and treated in the ER.”
There was definite consensus that nurse-patient ratios impact the identification of sepsis on medical-surgical floors, particularly when there are multiple patients with diverse needs. “It's a challenge to keep on top of all that information, manage your patient load, and be able to detect subtle changes that aren't always that obvious.” commented Sharon.
Perspectives on the Use of Sepsis Bundles
The use of sepsis bundles generated a range of viewpoints on sepsis intervention guidelines. Maureen began by acknowledging that bundles are important in guiding care, but also emphasized the value of clinical judgment. “Not every patient is the same, and although you want to treat sepsis in a standardized way, you have to take into consideration the patient's medical challenges.”
Connie Rathke, also a clinical sepsis specialist, agreed with Maureen on this last point, adding that “bundles can be redundant and potentially get dismissed since all the interventions—giving fluids, antibiotics, and drawing cultures—are often done before the EMRs or alert system signal the warning.”
Maureen, considering the alternative, recognized that “by not using the bundle, you potentially open the chance for error, because critical steps may get omitted.”
Kimberly’s experience was that overall, patients seem to have better outcomes if the bundles are followed. “In our facility we click off the steps we’ve done, and upon discharge, we still do follow-up care to make sure the patient doesn’t relapse.”
Sharon emphasized the need for follow-up due to the multifaceted nature of bundles, “Many of the interventions go hand-in-hand, yet are also very separate, complex issues. Once you initiate and identify the items in the bundle, you still need to manage effectively with the tools that are in your system.”
The Question of Fluid Resuscitation and Bundles
Building on the topic of sepsis bundles and tools for effective management, the conversation turned to antibiotics and fluid resuscitation, particularly the debate over timing and volume of fluid resuscitation in an intervention. Maureen noted that, “Fluid resuscitation is probably the biggest challenge because there are such diverse opinions among clinicians. The best of both worlds is using technology that can hit the mark for each individualized patient, not just a blind 30 [milliliters of fluid] per kilo resuscitation.”
Sharon made the point, drawn from simulations of sepsis care, that in some instances where providers on the care team disagree about the fluid resuscitation, “the challenge isn’t necessarily the protocol, but the dynamics between providers and how they discuss the best course of action for that patient.”
Artificial Intelligence in Sepsis Awareness
Expanding on the topic of sepsis awareness, this med-surg panel considered the potential for artificial intelligence (AI). Panelists agreed that AI has potential “to be a very valuable tool in fitting together the clinical picture” and “providing the nurse with an extra set of eyes, “another arm reaching out.”
Sharon offered, “AI may help with situational awareness; bringing visibility to data that sits in your EMR and on your device – and therefore monitoring thousands of pieces of data across multiple patients simultaneously whereas an individual can only assess them one at a time.”
Clinician Burnout and the Heightened Awareness for Sepsis
Achieving best practices in patient care led to further discussion on the challenges of nurse-patient ratios, clinician burnout and “compassion fatigue” in sepsis treatment. Given the multiple demands on medical-surgical nurses, panelists value the team approach, “Having extra people available, working together in tandem, and getting all the tasks done helps nurses to feel supported.”
Adding to the critical support element that teams bring, Maureen commented, “When we identify someone that is developing sepsis, if we can reduce the nurse’s stress about meeting the [one-hour bundle] deadlines by bringing help, that can also help to alleviate burnout.”
Sharon added, “Implementing these rapid response teams to assist in crisis situations is extremely important.” She also noted that, “On the flip side, I know alert fatigue is often mentioned hand in hand with burnout. Advancing AI and algorithms to reduce false positives can maybe help us focus more on those patients that are truly deteriorating.”
Maureen added, “We're in the infancy of AI, but as we learn how to manage it, AI is going to become even more precise and valuable.”
Closing Thoughts
Summing up their discussion, panelists’ appreciated the opportunity to share experiences regarding sepsis, noting that medical-surgical nurses are the “foundation of everything that we do for the sepsis patients; they educate, they advocate, and they are doing a wonderful job of taking care of these patients.”
Connie contributed a final comment that captured the spirit of the discussion, “Let's continue to network and have conversations with our colleagues because these types of experiences and success stories help us all to grow.”
