nursing.elitecme.com Page 49 Complete Your CE Test Online - Click Here might educate the patient during his stay as to signs and symptoms of infection of a surgical wound, or the importance of preventing pneumonia with the use of incentive spirometry postoperatively. In the outpatient setting, a nurse can educate patients as to the importance of vaccines to prevent such infections as pneumonia, meningococcus, and influenza vaccines, especially in those patients at high risk for infection. Nurses should encourage patients to quit smoking; smokers are at risk for pneumonia. Nurses can also take opportunities in everyday life to spread the word to the community and family and friends about signs and symptoms of worsening infection and who is at risk for sepsis because of comorbidities. Nurses can use the mnemonic SEPSIS to remember what to tell those they come in contact with (UK Sepsis Trust, 2016): S: Slurred speech. E: Extreme shivering or muscle pain. P: Passing no urine in a day. S: Severe breathlessness. I: “I feel like I might die.” S: Skin that is mottled or discolored. Another simple mnemonic, TPR (temperature, pulse, respirations), can be a useful tool to teach the lay population regarding when to call the doctor. If a person has an infection or flu and at least two of the three following symptoms, she should notify her doctor and tell him that she is concerned about sepsis (Sepsis Watch, n.d.): ● ● Temperature > 38.3˚C (101˚F) or < 36.1˚C (97˚F). ● ● Heart rate > 90 bpm. ● ● Respiratory rate > 20 to 22 rpm. Educating coworkers It is part of the nurse’s responsibility to ensure that other health care workers who come in contact with their patients follow proper techniques for infection control. The nurse should relay to others any contact precautions or neutropenic precautions that may be in place for a particular patient. If a nurse should see another health care worker not following proper protocol, she should educate the health care worker as to proper hand hygiene to protect not only other patients but also themselves. Sepsis protocols and sepsis rapid response teams Nurses are at the forefront of medical care. As such, continuing education for nurses is imperative to keep nurses up-to-date regarding evolving research on the pathology of sepsis and new evidence related to the care of patients with sepsis. Nurses can advocate for enactment and enforcement of sepsis protocols and the formation of sepsis response teams in their facility. They should always communicate with other members of the health care team to ensure timely response to an insidious process. Evidence-based practice guidelines should be part of the hospital policies on every unit, and nurses are responsible for setting the example in implementing these guidelines. The use of sepsis screening tools, sepsis protocols, and sepsis rapid response teams can help improve treatment and outcomes in patients identified early. An example of a sepsis rapid response team might include members of the hospital staff who have been thoroughly educated on sepsis and who can effectively communicate and work together to achieve a quick response and subsequent treatment of the patient suspected of having sepsis. A trained response team might include as members a physician, an ICU nurse, and a respiratory therapist. The Surviving Sepsis Campaign (SSC) gives the following example for an effective core leadership interdisciplinary team: ● ● Administrator over emergency department and critical care medicine. ● ● Critical care medicine (CCM) physician. ● ● ED physician. ● ● CCM nurse manager. ● ● ED nurse manager. ● ● ED charge/triage nurse. ● ● CCM charge nurse. Additional team members could include these health care professionals: ● ● Pharmacist. ● ● Respiratory therapy supervisor. ● ● Process improvement facilitator. ● ● Laboratory supervisor. ● ● Technicians from ED. An example of an effective sepsis work team includes the following (Surviving Sepsis Campaign, n.d.): ● ● ED physician. ● ● Triage nurse. ● ● Staff nurse. ● ● Laboratory technician. ● ● Laboratory supervisor. ● ● Admissions clerk. Additional team members could include these professionals: ● ● CCM physician. ● ● House officer. ● ● ICU charge nurse. ● ● Infectious disease physician. Nursing consideration: Nurses should advocate for a sepsis response team in their institution so they have the option for a member of the team to evaluate a patient they are concerned may have sepsis. PROGNOSIS Sepsis continues to have a high mortality rate. Long-term studies have shown a mortality rate as high as 37% to 52% for patients with sepsis (Liu et al., 2014). Septic shock carries a mortality rate approaching 50%, and the degree of organ failure and the number of organs involved are directly correlated to mortality (Mayr et al., 2014). Half of those who have a more severe form of sepsis are readmitted to the hospital in the two years following their discharge ( Korošec Jagodič,, Jagodič, & Podbreger, 2006). Patients who survive a more severe case of sepsis often have long- lasting effects that interfere with daily life. A study by Korošec Jagodič, Jagodič, and Podbregar (2006) found that 82% of patients who were treated in an ICU for sepsis or trauma had a moderate to extreme problem with at least one of the following: activities of daily living, self-care, pain or discomfort, and anxiety and depression. For elderly people who survive septic shock, it has been shown that there are long-term cognitive effects and functional disabilities that result from hypoperfusion (Iwashyna, Ely, Smith, & Langa, 2010). Those who survive sepsis are at risk for developing postsepsis syndrome. EBP alert! Postsepsis syndrome (PSS) occurs in up to 50% of patients who survive sepsis (Sepsis Alliance, n.d.). With this condition, physical or psychological symptoms may persist after the patient has been discharged from the hospital after being treated for sepsis. Postsepsis syndrome Postsepsis syndrome (PSS) occurs in up to 50% of patients who survive sepsis (Sepsis Alliance, n.d.). With this condition, physical or psychological symptoms may persist after the patient has been discharged from the hospital after being treated for sepsis. Symptoms of postsepsis syndrome can be physical or psychological and vary in severity (Sepsis Alliance, n.d.): ● ● Insomnia, difficulty getting to sleep or staying asleep. ● ● Nightmares, vivid hallucinations, and panic attacks.