1Calvary Health Care Bruce, Giralang , Australia
Sepsis and septic shock continues to be a major healthcare problem worldwide.
Australia’s Society of Critical Care Medicine’s Surviving Sepsis campaign highlighted that the early identification and appropriate management of sepsis improves patient outcomes. This recognition has bought about an increased focus on the definition of sepsis, with the third international consensus definition for sepsis and septic shock (Sepsis 3) being released in 2016. The definition of sepsis evolves in light of considerable advances in the understanding of sepsis’ pathobiology, management and epidemiology. The recommendations from Sepsis 3 were that sepsis should be defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. The quick Sequential (sepsis-related) Organ Failure Assessment (qSOFA) scoring system was developed from the work of the international consensus group on sepsis, as a bedside screening tool for clinicians to identify patients who may have a prolonged Intensive Care Unit stay or mortally due to sepsis. This tool identifies at risk patients who need timely targeted care to reduce associated morbidity and mortality.
Within our ED we modified existing sepsis pathways to incorporate the qSOFA tool to improve the recognition of patients with sepsis, enabling rapid intervention. As with all change, the pathway has had a mixed reaction from clinicians on the floor. During the implementation of the pathway, the primary concern was that the pathway was not capturing the right patients. Despite this concern, there has been an improvement in how we treat sepsis patients in the department.
qSOFA was one of the many contributing factors, alongside an increased department wide focus on sepsis and a clear treatment progression as laid out in the pathway. Due to the many factors involved, I would argue such improvements cannot be attributed to qSOFA alone. Other aspects of the pathway such as the empowerment of nursing staff to be able to recognise and initiate the sepsis pathway may have had a greater impact than qSOFA alone. This is not to suggest that qSOFA is not a valuable tool, yet qSOFA is a set of cues or prompts to suggest sepsis, the true detection of sepsis remains at the bedside, by a clinician.
Dale Reading is a registered nurse at the emergency department working at Calvary Public Hospital Bruce. Dale graduated from the University of Canberra with a Bachelor of Nursing and continued postgraduate studies in emergency nursing at the University of Tasmania. Dale has been involved in a number of quality improvement projects to improve clinical practice and is currently focused on nurse’s assessment of patient in the ED.