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Running Head: SEPSIS EDUCATION TO IMPROVE RECOGNITION
In Emergency Department nurses, does nursing education improve recognition of signs and
symptoms of sepsis and knowledge of a hospital sepsis protocol?
Lauren Waltman and Frances Zondlo
The Pennsylvania State University-Capitol Campus
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SEPSIS EDUCATION TO IMPROVE RECOGNITION
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Abstract
The purpose of this capstone research project was to determine if increasing awareness,
education, and knowledge of a sepsis protocol bundle improved identification of signs and
symptoms of sepsis. Multiple evidence-based research articles were utilized to address this
purpose. It was found in result comparison of pre and post quizzes provided to emergency
department nurses, that identification of sepsis improved when staff was provided with
educational materials. The research revealed that with increased knowledge, nurses were more
confident in their abilities to better care for patients and enabled to more quickly identify the
signs and symptoms associated with sepsis. It was also identified that nurses need to increase
communication, both nurse to nurse and nurse to doctor, to decrease the lag time in care.
Keywords: sepsis, protocol bundles, nurse education, patient outcomes, signs and symptoms
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Problem Statement
Sepsis is a quick and sometimes silent killer among hospitalized patients. There has been
a growing incidence of sepsis, severe sepsis, and septic shock. Turi and Von Ah (2013) state that
sepsis affects approximately 750,000 Americans annually. Even more shocking is that fact that
between 28 to 50% of those cases end in death, which has made sepsis now the 10th leading
cause of death (Turi and Von Ah, 2013).
These authors were intrigued by these statistics and researched into why this is occurring.
After reviewing information about sepsis knowledge within the medical field, it was determined
that the severity and time-sensitivity of sepsis is not at the highest priority. Furthermore, these
writers concluded that this lack of knowledge could be aiding in the number of sepsis cases each
year. Without the appropriate knowledge base, nurses, who are on the frontlines, are not fully
equipped to catch the subtle signs that indicate sepsis. Even more on the frontline of patient care
are emergency department nurses, whom are tasked with quick and efficient assessment of
patient complaints to give the doctor the best shot at a correct diagnosis.
Therefore, the PICO question proposed for this capstone project is in Emergency
Department nurses, does nursing education improve recognition of signs and symptoms of sepsis
and the utilization of a hospital sepsis protocol? As these writers completed capstones in the
Harrisburg Hospital emergency department, it was determined that this topic is pertinent and
sustaining with the continued growth in sepsis cases annually.
Kliger, Signer, and Hoffman (2015) found that when a Nurse Leadership program was
implemented into study hospital in order to reduce sepsis, there was a decrease in mortality rates.
However, there was a marked increase in the number of reported cases of severe sepsis/septic
shock. These researchers believe that when there was increased knowledge of the signs and
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symptoms of sepsis, the so-called silent killer was more readily diagnosed. In a similar study by
Delaney, Friedman, and Fitzpatrick (2015), it was stated that there was an increased risk of
mortality by 7.6% for each hour that sepsis goes undiagnosed.
Based on the above information and review of Harrisburg Hospital’s current sepsis
protocol, these writers determined that more light needs to be shed on this disease to increase
nurse knowledge and, ultimately, patient outcomes. By testing baseline knowledge and
increasing education of sepsis, this disease can be better managed and save lives.
Literature Review
Search of the Literature
In order to gain knowledge on sepsis, nurse knowledge, and protocol bundles, these
authors completed an electronic search of the current literature using PubMed, Nursing
Reference Center, and CINAHL. To narrow the search, the following search terms were used:
“sepsis protocol bundles”, “nurse utilization of sepsis bundles”, “emergency department sepsis
protocols”, “nursing”, “knowledge”, “sepsis”, “baseline”, “nursing education”, “early detection
of sepsis”, “detection of sepsis”, “nurse impact”, and “patient outcomes using sepsis protocol.”
The articles were reviewed based on support for nurse education and increasing knowledge of
sepsis, determination of increasing education to increase septic patients outcomes, and nurse
utilization of a sepsis protocol bundle and patient outcomes in adult patients presenting to the ED
with suspected sepsis.
Critical Appraisal of the Evidence
Nurse’s Knowledge of Sepsis
In reviewing the literature, it is daunting to see the results and confidence of nurses with
regard to, first, identification of sepsis. Robson, Beavis, and Spittle (2007) surveyed 73 nurses to
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gather baseline information about their ability to detect and identify sepsis, including the signs
and symptoms. The authors’ survey included identification of the SIRS criteria; five case
studies, in which the nurses had to identify if the patient had sepsis and then what would be the
appropriate intervention(s); and ten true or false questions that outlined the standard definitions
of sepsis. Based on the results of the audits, it appeared that nurses in the study did not have a
solid understanding of sepsis and all of the criteria that aid in classification. It is common
knowledge that a high temperature is a key sign of infection and either a high (>38 oC) or low
(<36 oC) temperature is one of the criteria for a SIRS diagnosis. 97% knew that a high
temperature was a sign, whereas only 22% of surveyed nurses knew that a low temperature could
also indicate sepsis (Robson et al., 2007). Elevated lactate levels are another diagnostic
indication of sepsis, but this survey found that there was “general lack of awareness among ward
nurses” to this regard as nurses responded that they were unsure when questioned about lactate
levels (Robson et al., 2007).
Nurses’ Confidence with Sepsis Diagnosis
As novice nurses are emerging from school and entering the workplace, confidence is an
area that needs improvement as knowledge and experience increase. One study, performed on
the use of educational programs to increase nurse knowledge, shed light on confidence of nurses
in identifying sepsis (Delaney, Friedman, Dolansky, & Fitzpatrick, 2015). In this study, nurses
participated in a pre-and posttest that included an educational component series between the tests
to increase knowledge. The tests examined the nurses in the following areas: “Institute for
Healthcare Improvement (IHI) bundles, health literacy and cultural competency, TeamSTEPPS
communication and teamwork, and staging sepsis” (Delaney et al., 2015). Of importance to
note, the tests also questioned the nurse’s confidence in identifying signs and symptoms of
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sepsis, ability to treat septic patients, and confidence to get the team on the same page for early
goal-directed therapy (EGDT) (Delaney et al., 2015). After the educational programs were
completed, the nurses underwent similar testing to determine effectiveness of the education on
the nurse’s knowledge and confidence. It should be noted that the subjects of this study were
nurses in a yearlong fellowship for emergency and critical care nursing.
Based on the posttest results from the multimodal educational program, the education
was shown to improve the nurse’s knowledge of sepsis, increase abilities to identify sepsis, and,
most importantly, increase their confidence in their abilities to perform the above (Delaney et al.,
2015). Confidence plays a key role in the nurse’s abilities to care for their patients effectively.
Having all of the knowledge without the confidence to speak up and advocate for their patient, is
a disservice to the patients that are entrusted into our care.
Use of Early-Goal Directed Therapy to Improve Outcomes
Rivers et al. (2001) was a study done on patients with sepsis that resulted in the largest
improvement in mortality outcome based off of early-goal directed therapy (EGDT). These
authors discussed that most patients with sepsis would be admitted to the ICU; however,
treatment for sepsis should start prior to the ICU, specifically in the ED. The authors state, “The
transition to serious illness occurs during the critical “golden hours,” when definitive recognition
and treatment provide maximal benefit in terms of outcome” (p. 1368). The purpose of the study
was to determine whether EGDT before admission to the ICU would improve mortality rates in
patients with severe sepsis or septic shock.
Rivers et al. (2001) found that in-hospital mortality was significantly higher in the
standard care group when compared to the EGDT group. The authors found significant benefits
in outcomes when therapy was implemented at an earlier stage of disease. It was also stated that
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earlier identification of sepsis leads to earlier treatment of the illness, thus opening the doors for
future researchers to study recognition of the signs and symptoms of sepsis.
Use of a Sepsis Protocol Bundle to Improve Outcomes
The Surviving Sepsis Campaign (SSC) is somewhat of the “gold standard” for what
many hospital protocol bundles are based on currently. The 2012 guidelines are the most recent
steps for healthcare providers to take in order to properly execute the treatment for patients with
sepsis. The campaign uses expert opinion to evaluate research studies and grade the
recommendations on their effectiveness for providers to be informed of the most effective care to
be given to patients. The guidelines include that the following should be done within 3 hours
from the time of presentation to the ED: measure serum lactate level, obtain blood cultures prior
to antibiotic infusion, and infuse 30 mL/kg of an intravenous (IV) crystalloid solution in patients
with hypotension (SBP <90 mmHg) or hyperlactemia (serum lactate level of 4 mmol/L or
greater) (Dellinger et al., 2013).
Wang, Xiong, Schorr, and Dellinger (2013) and MacRedmond et al. (2010) both
conducted studies that aimed to compare patients and outcomes before and after the
implementation of a sepsis bundle in the ED. The overall results of both studies were that inhospital mortality significantly decreased in patients after a protocol was implemented. These
authors noticed that it seemed both studies had mortality statistics that were mirrored images of
compliance with the bundles.
Yealy et al. (2014) was yet another study based on the Rivers et al. study completed in
2001. This study was conducted with the mindset that treatment for sepsis had drastically
changed since the Rivers study and thus set out to see if all of the elements of the Rivers protocol
were still a necessity. The study concluded that mortality rates of the protocol groups did not
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differ significantly from the usual care group. These authors believe that these results may have
been erroneous due to the fact that the one protocol group allowed the treating physicians to
choose which vasopressors and fluid to treat the patients with, which was no different than the
usual care group that allowed the providers to direct all care. The results of this study also could
have been inaccurate because the authors discuss how the same trained physician-led team
implemented both of the protocols. Perhaps using the same team could have influenced the
results in a way that did not represent accuracy.
Education of Staff on Sepsis and Protocol
A theme in almost all of the research articles evaluated in this literature review involved
some sort of education of staff on sepsis and the protocol that was to be used. Much of the
education was of the ED nurses and physicians through mandatory online learning or regular
meetings about the SSC’s guidelines and the protocol that would be put into place. The issue
that this author identifies is the concern of a Hawthorne effect. If training was completed before
the protocol was implemented, perhaps the use of it by the staff was influenced by the education.
The staff could be on high alert of the damage sepsis can cause and the need for timely treatment
of these patients, and thus results may have been skewed. This would be a good thing in the
“real-world;” however, this may have influenced the results of the studies evaluated in this
review and produced erroneous results. Tromp et al. (2010) did things a bit differently and
initiated training six months after initiation of the sepsis protocol, instead of before initiation like
many of the other studies discussed in this review. It was discussed that possibly recognition of
the signs and symptoms of sepsis could be a barrier to recognition by nurses. Outcomes of the
patients in this study significantly improved when nurses were educated and involved in the
initiation of the sepsis protocol.
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MacRedmond et al. (2010) focused on the education of ED nurses on what sepsis is and
how early recognition can help improve outcomes. The researchers also looked at things a bit
differently with the education provided. Since most of the patients with sepsis are admitted to
the ICU after the ED, the researchers focused on bridging the gap between the ICU and ED
nurses and had the ED nurses pair up with an ICU nurse for further practice on monitoring and
treating these patients.
Action Plan
Since the beginning of the 21st century, sepsis has become an increasingly more prevalent
mass murderer. The Center for Disease Control’s (CDC) National Center for Health Statistics
(NCHS) (2014) stated that from 2000 to 2008 there was a near 50% increase in the number of
reported sepsis cases in the United States. Dumont and Harding (2013) state that severe sepsis
accounts for almost 500,000 ED visits annually in the United States. It is because of these
startlingly statistics that these authors planned to evaluate and shed light on this growing and
deadly disease.
These authors intended to research if educating emergency room nurses on the signs and
symptoms of sepsis as well as using a sepsis protocol will aid in earlier identification of sepsis
and improve patient outcomes. This study was performed at Pinnacle’s Harrisburg Hospital ED,
where these authors completed their capstones. These researchers utilized their preceptors/team
members to gain participation of unit RNs. This study’s results were shared with the unit
manager to aid in further investigation and education of the staff.
Twenty emergency department staff nurses completed a pre-quiz to obtain baseline
information of sepsis knowledge. The quiz can be found in Appendix A. The quiz was comprised
of four sections to evaluate nurses’ knowledge of sepsis, knowledge of hospital protocol for
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sepsis, and confidence in recognition and treatment of sepsis. Data was compiled from each
section and translated into percentages based on participants’ responses.
These researchers intended to develop an educational bulletin board to be posted in the
unit break room. The educational board was to be posted for two weeks in order to allow for all
participating nurses to review the presented information. However, due to environmental
restraints, these researchers formulated an educational flyer to be distributed to the participants.
This decision was made to provide participants with handheld information that could be easily
referenced and re-obtained if necessary. The information on the flyer reflected the areas of
knowledge deficit of the nurses based on the pre-quiz results that are crucial for sepsis
identification and protocol utilization. The flyer outlined the following information (see
Appendix C):
1) Definition of sepsis and septic shock.
2) SIRS (Systemic Inflammatory Response Syndrome) criteria as per Pinnacle Health’s
Protocol. See Appendix B.
3) Sepsis alert protocol used at Pinnacle’s ED
4) Lactate levels
5) Important facts about sepsis.
The educational flyer and post-quiz were hand delivered to the same twenty staff nurses.
At that time, nurses were instructed to review the educational material and complete the postquiz. Nurses were excluded from this study if they were unable or unwilling to participate in the
educational phase or the post-quiz. The post-quiz was comprised of the same four sections as the
pre-quiz which included evaluating nurses’ knowledge of sepsis, knowledge of hospital protocol
for sepsis, and confidence in recognition and treatment of sepsis. The post-quiz results were
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compiled and translated into percentages to aid in easy comparison to the pre-quiz results. This
allowed determination of the efficacy of the implementation of an educational flyer in the unit.
The post-quiz can be found in Appendix D.
These authors utilized the same quiz prior to and after providing the educational materials
to ensure continuity of results. Participants were not made aware of the correct answers after
completing the pre-quiz in order to limit skewed results due to memorization.
In addition, these authors added a post-quiz addendum to evaluate if the educational
materials were beneficial in aiding in the nurses’ education about sepsis and the protocol in place
at Pinnacle. The addendum was also added to evaluate if the authors’ goals, listed above, were
met. This addendum was put in place with the goal of sharing the results with the nurse manager
of the unit to aid in possible future staff education.
As discussed above, the plan for this project was to provide insight into the knowledge of
the nurses on sepsis and its protocols in the emergency department at Harrisburg Hospital. To
achieve this goal, these authors implemented an educational flyer to provide information on the
recognition of sepsis and the protocols in place at Harrisburg Hospital. A pre-quiz and post-quiz
were given to the nurses to evaluate the usefulness of the education materials provided. The
education and testing method used for this study can be altered and applied to all hospital
settings, as any patient is susceptible to this deadly disease.
Summation
These authors completed a comprehensive review analysis of the pre and post quiz results
completed by the participating ED nurses. The review revealed multiple common themes and
misconceptions related to sepsis identification and the protocol that is currently in place at
Harrisburg Hospital.
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Out of the 20 pre-quizzes completed, it was found that 95% of nurses reported confidence
in their abilities to identify early signs and symptoms of sepsis and care for a patient with sepsis.
Despite this reported confidence, 75% of nurses failed to recognize key signs and symptoms of
sepsis. The most commonly missed signs by the nurses were a temperature of
< 36C, white blood cell count of <4, HR >90 and lactate level of >2 mmol/L. In addition to these
missed signs of sepsis, nurses were also unable to correctly differentiate in the case studies
between a patient with a local infection and a patient who has a source of infection that has led to
sepsis. Based on the results of Case Study 2 (See Appendix D), a portion of the nurses believed
that the patient was presenting with solely a urinary tract infection and dismissed other pertinent
information that should have clued them into the patient becoming septic.
The other major finding from the pre-quiz results was that nurses were aware that fluid
resuscitation is necessary for treatment of sepsis and decreased mortality. However, when these
researchers further discussed the results with the participating nurses, the nurses disclosed that
fluid resuscitation should include a 1000 mL bolus within one hour of diagnosis of sepsis. Based
on Harrisburg Hospital’s sepsis protocol, the fluid resuscitation is to consist of a 500 mL normal
saline solution bolus given over 30 minutes. It became apparent that further education on the
protocol was required based on the results of this pre-quiz.
Based on the above mentioned action plan, these researchers intended to obtain post-quiz
results from the same twenty ED nurses that completed the pre-quiz in order to compare efficacy
of the educational flyer. Post-quizzes and educational materials were provided to these twenty
nurses, however only ten of the twenty post-quizzes were returned to these researchers. Due to
only 50% of the quizzes being completed, an identified limitation of this study was a gap in
results due to an inability to adequately compare all twenty pre and post quizzes. Ideally, the
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participating nurses would have completed the post-quiz upon receiving them in order to return
promptly to these researchers. Due to the environment of the emergency department, this is an
unrealistic expectation and thus the quizzes were completed on the nurse's personal time
schedule, which did not correlate with the research time schedule. These researchers believe that
these circumstances accounted for the lack of post-quiz participation.
Out of the post-quizzes received, it was revealed that the educational flyer provided
improved nurses identification of early signs and symptoms of sepsis as well as knowledge of the
protocol. 100% of the participating nurses were able to correctly identify key signs of sepsis,
including the signs previously missed on the pre-quiz as mentioned above. The post-quiz also
revealed improvement in recognition of potential sepsis versus a local infection based on Case
Study 2 as well as fluid resuscitation per the hospital’s protocol.
These researchers concluded that given more time and resources, results could have been
more comprehensive. Ideally, all emergency department nurses would have completed the pre
and post quizzes with different methods of education used in addition to the flyer. Another aspect
of this research that was unable to be fulfilled was increasing communication laterally and
horizontally due to time restraints. These authors realize that sepsis is a systemic disease and that
the identification and treatment should be a systemic goal within the given hospital organization.
In conclusion, these researchers found based on this small-scale study, that there are
identified needs for education within the Harrisburg Emergency Department nurses for
recognition of sepsis. Based on conversations with the managers in the ED, statistics of sepsis
identification in Harrisburg ED have gotten worse. This research was of key importance and they
are striving to improve the numbers and thus improve patient outcomes. These researchers
believe that this need for education is most likely apparent in most emergency departments in the
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US. Due to the fact that the emergency department is where these patients present first with
potential sepsis, it is crucial that further education be provided to nurses and staff who have the
potential to recognize key signs and symptoms of this continuously growing deadly disease.
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References
Delaney, M. M., Friedman, M. I., Dolansky, M. A., & Fitzpatrick, J. J. (2015). Impact of a
Sepsis Educational Program on Nurse Competence. Journal Of Continuing Education In
Nursing, 46(4), 179-186. doi:10.3928/00220124-20150320-03.
Dellinger, R. P., Levy, M. M., Rhodes, A., Annane, D., Gerlach, H., Opal, S. M., & ... Moreno,
R. (2013). Surviving sepsis campaign: international guidelines for management of severe
sepsis and septic shock: 2012. Critical Care Medicine, 41(2), 580-637.
doi:10.1097/CCM.0b013e31827e83af
Dumont, L., & Harding, A. D. (2013). Development and Implementation of a Sepsis Program.
JEN: Journal Of Emergency Nursing, 39(6), 625-630 6p. doi:10.1016/j.jen.2013.08.009
Kliger, J., Singer, S. J., & Hoffman, F. H. (2015). Using the Integrated Nurse Leadership
Program to Reduce Sepsis Mortality. Joint Commission Journal On Quality & Patient
Safety, 41(6), 264-272.
MacRedmond, R., Hollohan, K., Stenstrom, R., Nebre, R., Jaswal, D., & Dodek, P. (2010).
Introduction of a comprehensive management protocol for severe sepsis is associated
with sustained improvements in timeliness of care and survival. Quality & Safety In
Health Care, 19(5), e46. doi:10.1136/qshc.2009.033407
Rivers, E., Nguyen, B., Havstad, S., Ressler, J., Muzzin, A., Knoblich, B., & ... Tomlanovich, M.
(2001). Early goal-directed therapy in the treatment of severe sepsis and septic shock.
New England Journal Of Medicine, 345(19), 1368-1377.
Robson, W., Beavis, S., & Spittle, N. (2007). An audit of ward nurses' knowledge of sepsis.
Nursing In Critical Care, 12(2), 86-92.
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Tromp, M., Hulscher, M., Bleeker-Rovers, C., Peters, L., van den Berg, D., Borm, G., & ...
Pickkers, P. (2010). The role of nurses in the recognition and treatment of patients
with sepsis in the emergency department: a prospective before-and-after intervention
study. International Journal Of Nursing Studies, 47(12), 1464-1473.
doi:10.1016/j.ijnurstu.2010.04.007
Turi, S. K., & Von Ah, D. (2013). Implementation of Early Goal-directed Therapy for Septic
Patients in the Emergency Department: A Review of the Literature. JEN: Journal Of
Emergency Nursing, 39(1), 13-19. doi:10.1016/j.jen.2011.06.006
Wang, Z., Xiong, Y., Schorr, C., Dellinger, R. P. (2013). Impact of sepsis bundle strategy on
outcomes of patients suffering from severe sepsis and septic shock in China. The
Journal of Emergency Medicine. 44(4), 735-741. doi:10.1016/j.jemermed.2012.07.084.
Yealy, D. M., Kellum, J. A., Huang, D. T., Barnato, A. E., Weissfeld, L. A., Pike, F., & ...
Angus, D. C. (2014). A randomized trial of protocol-based care for early septic shock.
New England Journal Of Medicine, 370(18), 1683-1693. doi:10.1056/NEJMoa1401602
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Appendix A
Pre-Quiz
1) I feel competent to identify patient’s exhibiting early signs and symptoms of sepsis.
Yes No
Not sure
2) I feel competent in my ability to care for patients’ diagnosed with SIRS, sepsis, severe sepsis,
and septic shock.
Yes No
Not sure
3) I feel competent to mobilize the healthcare team to begin early-goal directed therapy.
Yes No
Not sure
True or False
1) Sepsis is the presence of a known or suspected infection accompanied by an inflammatory
response.
True
False
Do not know
2) Septic shock is severe sepsis with refractory hypotension (low BP despite fluid resuscitation).
True
False
Do not know
3) Sepsis kills more people than breast cancer, prostate cancer, and AIDS combined.
True
False
Do not know
4) The nurse should obtain blood cultures prior to administration of broad-spectrum antibiotics.
True
False
Do not know
5) After the physician is notified of possible sepsis, the nurse should administer a 500 mL NSS
bolus in 30 minutes.
SEPSIS EDUCATION TO IMPROVE RECOGNITION
True
False
18
Do not know
Which of the following are signs of sepsis?
1) Temperature >38.3 C
Yes
No
2) Temperature <36.0 C
Yes
No
3) WBC count of > 12
Yes
No
4) WBC count of < 4
Yes
No
5) HR > 90 bpm
Yes
No
6) Lactate level of >2 mmol/L
Yes
No
Do not know
Do not know
Do not know
Do not know
Do not know
Do not know
Directions: Identify if you would categorize the following patients as having suspected sepsis. If
you do not think sepsis is suspected, briefly write what you believe it is the patient is presenting
with.
Case Study 1:
Ms. Hill is a 35-year-old female who presents to the ED post right sided mastectomy 7 days ago.
She has a JP drain on her right side draining serosanguinous fluid and the area around the drain is
red, swollen, and warm to touch. Vitals signs: Temp 39, HR 128, RR 24, BP 112/84, O2 Sat 95%
on RA. Labs are pending.
Suspect Sepsis? (circle one)
Yes
No
If no, please explain: ______________
Case Study 2:
Mr. Charles is a 75-year-old male who is brought to the ED by his daughter for new onset
confusion. His daughter reports that he has not voided in the last 6 hours. Vital signs: Temp 35.2,
HR 85, RR 16, BP 100/60, O2 Sat 98% on RA. CBC reveals a WBC count of 15.
SEPSIS EDUCATION TO IMPROVE RECOGNITION
Suspect Sepsis? (circle one) Yes
No
If no, please explain: _________________
Appendix B
As per Pinnacle Health’s Protocol
- HR of > 90 beats/min
- Tachypnea (RR of >20 breaths/min)
- Hypoxia of <90% oxygen
- Hyperthermia of > 38.3 C or Hypothermia of 36 C
- White blood cell count of > 12,000 or < 4,000 cells/mm3, or bands >10%
- Significant edema
- PaCO2 < 32 mmHg
- Altered mental status
- Non diabetic serum glucose >120
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SEPSIS EDUCATION TO IMPROVE RECOGNITION
Appendix C
20
SEPSIS EDUCATION TO IMPROVE RECOGNITION
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Sepsis: The Silent Killer
* Se p s i s a c c o u n t s f o r
5 0 0 , 0 0 0 ED v i si t s
a n n u a l l y i n t h e US
* Se p si s k i l l s m o r e t h a n
b r e a st c a n c e r , p r o st a t e
c a n c e r , a n d AI DS
com b i n ed .
D id you know?
SI RS CRI TERI A
SIRS=Systemic Inflammatory
Response Syndrome
- Temperature > 38.3 and <36.0
- WBC count >12 and <4
- HR >90 bpm
- Respirations >20 breaths/min
- Significant edema
- PaCO2 < 32 mmHg
- Altered mental status
- Non diabetic glucose >120
- Classification of Sepsis can only be established when:
- patient meets 2 SIRS criteria
- patient has suspected or confirmed infection
- Ideally, blood cultures should be obtained prior to antibiotic
administration
- Positive Serum lactate screen is used as a diagnostic test for
sepsis because it is associated with mortality.
- Lactate levels >2 mmoL/L are considered
hyperlactatemia
- Classification of Septic Shock can only be established when:
- patient meets criteria for sepsis
- patient has refractory hypotension (low BP despite
fluid resuscitation)
Please refer to back side of this flyer for
Pinnacle Health’s sepsis protocol!
Appendix D
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22
Post-quiz
1) I feel competent to identify patient’s exhibiting early signs and symptoms of sepsis.
Yes No
Not sure
2) I feel competent in my ability to care for patients’ diagnosed with SIRS, sepsis, severe sepsis,
and septic shock.
Yes No
Not sure
3) I feel competent to mobilize the healthcare team to begin early-goal directed therapy.
Yes No
Not sure
True or False
1) Sepsis is the presence of a known or suspected infection accompanied by an inflammatory
response.
True
False
2) Sepsis kills more people than breast cancer, prostate cancer, and AIDS combined.
True
False
3) Sepsis kills more people than breast cancer, prostate cancer, and AIDS combined.
True
False
Do not know
4) The nurse should obtain blood cultures prior to administration of broad-spectrum antibiotics.
True
False
Do not know
5) After the physician is notified of possible sepsis, the nurse should administer a 500 mL NSS
bolus in 30 minutes.
True
False
Do not know
Directions: Identify if you would categorize the following patients as having suspected sepsis.
SEPSIS EDUCATION TO IMPROVE RECOGNITION
23
Case Study 1:
Ms. Hill is a 35 year old female who presents to the ED post right sided mastectomy 7 days ago.
She has a JP drain on her right side draining serosanguinous fluid and the area around the drain is
red, swollen, and warm to touch. Vitals signs: Temp 39, HR 128, RR 24, BP 112/84, O2 Sat 95%
on RA. Labs are pending.
Suspect Sepsis? (circle one) Yes
No
If no, please explain: ______________
Case Study 2:
Mr. Charles is a 75 year old male who is brought to the ED by his daughter for new onset
confusion. His daughter reports that he has not voided in the last 6 hours. Vital signs: Temp 35.2,
HR 85, RR 16, BP 100/60, O2 Sat 98% on RA. CBC reveals a WBC count of 15.
Suspect Sepsis? (circle one) Yes
No
If no, please explain: _________________
Postquiz addendum:
Did you find the educational board useful in the following areas:
1) Describing the difference between sepsis and septic shock?
Yes
No
2) Informing you of the SIRS criteria?
Yes
No
3) Informing you of the sepsis/septic shock protocol?
Yes
No
4) Do you feel better prepared to identify a potentially septic patient?
Yes
No