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Providing nurses with current evidence to inform practice for treatment of patients with sepsis, coupled with appropriate tools (electronic screening and scripting) for report of positive screens, forms a strong foundation on which to build an interprofessional and organizational sepsis treatment program.
Sepsis is caused by overwhelming immune response to infection. Risk factors include baseline immunocompetence of the patient, presence of comorbid conditions, and patient age (Kleinpell & Schorr, 2014). Severe sepsis can cause damage to and failure of multiple organ systems. In sepsis, chemicals released by the body to fight infection trigger widespread inflammation. Chemical mediators released through the sepsis response damage the endothelial lining of blood vessels and lead to increased capillary leakage. Cytokine release prompts production of adhesion molecules on vascular endothelial cells and neutrophils, causing further endothelial injury through release of the neutrophil components. Activated neutrophils release nitric oxide, a potent vasodilator that contributes to septic shock (Opal & van der Poll, 2015). These events collectively can cause vasodilation, hypotension, misdistribution of blood flow, and hypoperfusion and dysfunction. Sepsis severity and the time to sepsis recognition and treatment impact the likelihood of mortality from organ dysfunction (Kleinpell & Schorr, 2014).
Severe sepsis is a significant problem, with an incidence of 300 to more than 1,000 cases per 100,000 persons annually in the United States (Gaieski, Edwards, Kallan, & Carr, 2013). For 2000-2008, the rate of hospitalized patients with a principal diagnosis of septicemia or sepsis more than doubled from 11.6 to 24.0 per 10,000 patients, with inhospital mortality of 15%-30%; mortality associated with severe sepsis ranged even higher at 30%60% (Hall, Williams, DeFrances, & Golosinskiy, 2011). A brief by Torio and Andrews (2013) reported sepsis resulted in an aggregate healthcare cost of $20.3 billion in 2011. Hall and colleagues (2011) identified the estimated annual inpatient cost of sepsis nationwide in 2008 as $14.6 billion.
Nurses play a vital role in early sepsis recognition and initiation of targeted treatment. Nurses' ability to assess a patient's vital signs and physical condition is key to early sepsis recognition (Kleinpell & Schorr, 2014). For knowledgeable screening, nurses must be familiar with a patient's sepsis risk factors and predisposition for infection (e.g., chronic disease, impaired immunocompetence), as well as factors likely to contribute to organ...