ebp and sepsis

Evidence Based Practice and Sepsis Evidence Based Practice and Sepsis BundlesBundles

How Evidence Based Practice is used to Develop Sepsis Care Bundles

byTony L. Blair

http://www.caresearch.com.au/caresearch/tabid/1590/Default.aspx

The University of Texas at El PasoNURS 5423Evidence Based Practice I

Learning ObjectivesLearning Objectives To discuss a brief

overview/definition of evidence based practice

To discuss the rating system for the hierarchy of evidence for intervention/treatment questions (I-VII) in searching for best evidence

To outline a brief discussion of sepsis (three forms and treatments)

To outline evidence based recommendations by the 2008 Surviving Sepsis Campaign for treating sepsis (severe sepsis and septic shock) using care bundles

To identify the need for using care bundles in the ED

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Learning GoalsLearning GoalsNurses Will:

• Be able to define evidence based practice. (Cognition)

Be introduced to the seven levels in the evidence rating system. (Cognition)

Be able to discuss the importance of using EBP and how it affects patient care. (Human dimension)

Be able to differentiate the three forms of sepsis (Cognition)

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Learning GoalsLearning GoalsNurses will

Review the signs and symptoms of severe sepsis/septic shock. (Cognition)

Review the two types of sepsis bundles developed through EBP. (Integration)

Discuss the importance of sepsis care bundles and how their use can improve patient outcomes. (Integration)

Discuss how EBP is used to influence change in practice in the healthcare setting and improve patient treatment outcomes. ( Lifelong learning & Caring)

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Background on Evidence

Based Practice

What is Evidence Based Practice?

http://www.channelweb.co.uk/crn-uk/news/2023746/ca-launches-emea-wide-distribution-review

Hierarchy of EvidenceHierarchy of Evidence

Background on Sepsis

What is Sepsis

http://www.sepsistrust.org/communities/9/000/001/217/479/images/987964.jpg

Background on SepsisBackground on Sepsis Leading cause of

hospitalization in the US 28% mortality rate for

estimated 751,000 cases in the US annually

Exceeds annual death for MIs (8 %) and breast CA (12-19%) in the US

Kills 1 in 4 (approximately 1,400 people daily) worldwide

458,000 septic patients enter the hospital through the ED each year

http://blog.itriagehealth.com/wp-content/uploads/2010/07/blood-borne-infection.jpg

Types of SepsisTypes of SepsisUncomplicated (simple) sepsis:Inflammatory response to an infectionSevere Sepsis: Induced organ dysfunction (respiratory failure, acute renal

failure Hypo-perfusion/tissue hypoxia Lactic acidosis Acute alteration in mental state OliguriaSeptic Shock Hypo-perfusion despite

adequate fluid Accounts for a mortality of

about 50%http://ak.picdn.net/shutterstock/videos/19851/preview/stock-footage-animated-emoticon.jpg

Surviving Sepsis Campaign Surviving Sepsis Campaign 20082008

(Evidence–Based Practice & Sepsis)(Evidence–Based Practice & Sepsis)The Surviving Sepsis

Campaign 2008 aims to: Increase awareness,

understanding, and knowledge Change perceptions and

behavior Increase the pace of change in

patterns of care Influence public policy Define standards of care in

severe sepsis Reduce the mortality

associated with sepsis by 25% over the next 5 years

Improve the management of sepsis through targeted initiatives (SSC, 2008)

http://www.survivesepsis.org/#/surviving-sepsis/3525200

Signs & Symptoms of Signs & Symptoms of SepsisSepsis

(SIRS) Systemic Inflammatory Response Syndrome)(SIRS) Systemic Inflammatory Response Syndrome) Temp >38.3C/100.9F or

<36C/96.8F SBP less than 90 or MAP less

than 65 HR > 90 beats/min (sinus

rhythm) Respiratory rate > 20

breaths/min or PaCo2 < 32 mmHg

WBC > 12,000 cells/min3, < 4000 cells/min3, or 10% bands

New onset altered mental status or mental status change with previous altered mental status

SIRS is manifested when 2 or more of the S/S are present!!!

http://owloftheremove.blogspot.com/2010/01/news-of-sick-patient.html

Background on BundlesBackground on Bundles

What is a Bundle?

Evidence Based Practice and bundles

2008 Surviving Sepsis

Campaign sets guidelines for sepsis bundles

http://picasaweb.google.com/lh/photo/Hk0EGqDUQu-T3_1PSM7rZg

Two Types of Sepsis Two Types of Sepsis BundlesBundles

(1) Sepsis Resuscitation Bundle: (ED)

(EGDT) Early Goal Directed Therapy: Tasks that must be accomplished within the first 6 hours of presenting with severe sepsis/septic shock

http://futurity.org/wp-content/uploads/2010/03/emergency_room.jpg

Early Goal Directed Early Goal Directed TherapyTherapy

(EGDT)(EGDT) Therapy (EGDT) first 6 hours Two large bore IVs Measure serum lactate level Blood cultures prior to antibiotic

administration Administer broad-spectrum

antibiotics (within 1st hour) Treat hypotension/elevated

lactate level with fluids (deliver an initial minimum of 20 ml/kg of crystalloid or an equivalent: 1-2L over the first 30 min – 1 hour)

Repeat lactate level Apply vasopressors for ongoing

hypotension

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Early Goal Directed Early Goal Directed TherapyTherapy

(EGDT)(EGDT)Therapy (EGDT) first 6 hours Maintain adequate central

venous pressure (CVP) at 8-12 mmHg

Maintain adequate Scv02 (mechanically ventilated) to at least 70% (Central line placement)

Central venous (superior vena cava) or mixed venous oxygen saturation ≥ 70% or > 65%

Urine output greater than 0.5 ml/kg/hr (SSC, 2008)

http://www.mcw.edu/emergencymed/clinicalservices.htm

Two Types of Sepsis Two Types of Sepsis BundlesBundles

(2) Sepsis Management Bundle: (ICU)

Evidence based goals that must be completed within 24 hours for patients with severe sepsis, septic shock and/or lactate > 4 mmol/L (36 mg/dl)

http://nursing.advanceweb.com/Archives/Article-Archives/Secrets-of-Beacon-Success.aspx

ICU TreatmentICU Treatment Treatment measures

within 24 hours in ICU

Administer low dose steroids

Administer Recombinant human activated protein C

Maintain adequate glycemic control

Prevent excessive inspiratory plateau pressures (Carter, 2007).

http://neurosciences.beaumont.edu/neuro-icu

Importance of Sepsis Care Importance of Sepsis Care BundlesBundles

Grouped together using EBP

Relatively easy to develop, implement and audit

Ensures strong evidence based clinical practice is used

Enable clinicians to more reliably deliver the best possible care

http://kaynou.wordpress.com/2010/11/21/st-paddys-day-chapter-eight/

The Value of EBPThe Value of EBP(Improving Patient Outcomes)(Improving Patient Outcomes)

EBP Helps Clinicians: Avoid ineffective care

approach Avoid use of opinions and

conjectures Avoid errors in clinical

decision making Determine and maintain

consistently high quality and safety standards in medical/clinical practice

Speed up the process of transferring clinical research findings into practice

To potentially reduce health-care costs significantly

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ConclusionConclusion(Putting It All Together)(Putting It All Together)

Evidence-Based Practice

+Sepsis Care Bundles

=Improved Patient

Outcomes

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ReferencesReferencesAhrens, T, (2005). Evidence-based Practice: priorities and implementation strategies. AACN

Clinical Issues, 16(1), pp. 36-42. Retrieved from http://bmhlibrary.info/LD17995709.pdf

Billings, D.M. & Halstead, J.A. (2009). Teaching in nursing. A guide for faculty. St. Louis:

Saunders-Elsevier.

Dellinger RP, Levy MM, Carlet JM, et al. (2008). Surviving Sepsis Campaign: International guidelines

for management of severe sepsis and septic shock. Crit Care Med ; [published correction

appears in Crit Care Med 2008; 36:1394-1396] 36:296-327. Retrieved from

http://www.survivingsepsis.org/Pages/default.aspx

Carter, C. (2007), Implementing the severe sepsis care bundles outside the ICU by outreach.

Nursing in Critical Care, 12: 225–230. doi: 10.1111/j.1478-5153.2007.00242.x

Fulbrook, P. and Mooney, S. (2003). Care bundles in critical care: a practical approach to evidence-

based practice. Nursing in Critical Care, 8: 249–255. doi: 10.1111/j.1362-1017.2003.00039.x

http://bmhlibrary.info/LD17995709.pdf

http://www.survivingsepsis.org/Pages/default.aspx

ReferencesReferencesFrakes, M. (2007). Emergency Department Management of Severe Sepsis. Advanced Emergency

Nursing Journal, 25(3), 228-238. Retrieved from EBSCOhost.

Gerber, K. (2010), Surviving sepsis: a trust-wide approach. A multi-disciplinary team approach to

implementing evidence-based guidelines. Nursing in Critical Care, 15: 141–151.

doi: 10.1111/j.1478-5153.2009.00378.x

Melnyk, B. M., & Fineout-Overholt, E. (2011). Evidence-Based Practice in Nursing & Healthcare: A

Guide to Best Practice. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.

Open clinical (2011). Evidence based medicine. Retrieved from http://www.openclinical.org/ebm.html

Papatanassoglou, E. (2009). Sepsis bundles: time for a nursing initiative? Nursing in Critical Care,

14(4), 162-165. doi:10.1111/j.1478-5153.2009.00349.x

Slide # 1 image. Retrieved from http://www.caresearch.com.au/caresearch/tabid/1590/Default.aspx

http://www.openclinical.org/ebm.html

http://www.caresearch.com.au/caresearch/tabid/1590/Default.aspx

ReferencesReferencesSlide # 2 image. Retrieved from http://oeaeuprrp.blogspot.com/

Slide # 3 image. Retrieved from http://www.123rf.com/stock-photo/3d_bullseye.html

Slide # 4 image. Retrieved from



http://www.channelweb.co.uk/crn-uk/news/2023746/ca-launches-emea-wide-distribution-revi

ew



Slide # 8 image. Retrieved

from http://blog.itriagehealth.com/wp-content/uploads/2010/07/blood-borne-infection.jpg


http://ak.picdn.net/shutterstock/videos/19851/preview/stock-footage-animated-emoticon.jpg

http://oeaeuprrp.blogspot.com/

http://www.123rf.com/stock-photo/3d_bullseye.html





http://ak.picdn.net/shutterstock/videos/19851/preview/stock-footage-animated-emoticon.jpg

ReferencesReferencesSlide # 10 image. Retrieved from http://www.survivesepsis.org/#/surviving-sepsis/3525200







Slide # 14 image. Retrieved from http://www.theguanaco.com/tag/critical-care-2

Slide # 15 image. Retrieved from http://www.mcw.edu/emergencymed/clinicalservices.htm


http://nursing.advanceweb.com/Archives/Article-Archives/Secrets-of-Beacon-Success.aspx

Slide # 17 image. Retrieved from http://neurosciences.beaumont.edu/neuro-icu

http://www.survivesepsis.org/#/surviving-sepsis/3525200




http://www.theguanaco.com/tag/critical-care-2

ReferencesReferencesSlide # 18 image. Retrieved from http://kaynou.wordpress.com/2010/11/21/st-paddys-day-

chapter-eight/

Slide # 19 image. Retrieved from http://hatetoloveresearch.blogspot.com/2010/12/on-using-

evidence-based-practice-as.html

Slide # 20 image. Retrieved from http://geek-freemarketing.com/smart-web-design/how-to-

make-your-law-firm-stand-out-online/attachment/piecing-together-a-good-strategy

Slide # 21 image. Retrieved from http://www.americanprofile.com/

Steen, C. (2009). Developments in the management of patients with sepsis. Nursing

Standard. 23(48). 48-55. Retrieved from EBSCOhost.

Surviving Sepsis Campaign (2008). Retrieved from

http://www.survivingsepsis.org/About_the_Campaign/Pages/default.aspx

ebp and sepsis

Documents

sepsis severe sepsis

sepsis bundleshow evidence

infectionsevere sepsis

management of sepsis

sepsis care bundlesbytony

types of sepsis bundles

brief discussion of

forms of sepsis cognitionhttp