Welcome to the latest key papers and publications from the past few months focussing mainly on tissue viability in the nursing profession.
Please click on the links below and enter your OpenAthens username and password to download the full text or contact the library at esth.hirsonlibrary@nhs.net to request the full text.
Pressure ulcers: a clinical audit to determine compliance against the aSSKINg framework in an adult community nursing setting
Abstract: Assessment of pressure ulcer (PU) risk remains a challenge in clinical practice. The first part of this article (Martin and Holloway, 2024) discussed the evidence base underpinning the development of clinical guidelines for PUs alongside the creation of the bundle approach regarding PU prevention. This article, part two, presents the results of a clinical audit that explores compliance against a PU prevention bundle (the aSSKINg framework) in an adult community nursing setting in the south-east of England. The clinical audit was conducted between July-December 2021 and included records of 150 patients. Overall, compliance against the aSSKINg framework was poor, with only two criterion being met: equipment provision for chair and referral to the tissue viability team. Short-term recommendations are that mandatory PU training for staff in the management of PUs should be implemented, and the tissue viability nurse network should be increased. The long-term recommendation was the introduction of the aSSKINg framework as a template into the electronic patient record.
Source: Martin S. British Journal of Community Nursing, Sep 2024; 29(Sup9): S28 – S34
Nurses' views on changes to pressure ulcer categorisation: results of a Wound Care Alliance UK survey
Abstract: The Wound Care Association UK (WCAUK) is committed to supporting both the accurate and consistent delivery and reporting of pressure ulcers/injuries based on the best available research and evidence. It is known that strategic and clinical guidance to support the delivery of evidence-based care does have a significant impact. Recent proposals to change pressure ulcer categorisation led the WCAUK to undertake a questionnaire survey of its members. This article outlines the importance of evidence-based guidance on the categorisation and assessment of pressure ulcer, highlighted by the responses to published changes to pressure ulcer categorisation for nurses in England, and presents the results of the survey. The article concludes that, although the discipline of tissue viability is constantly developing, the changes must be based on evidence, and clinicians must be supported strategically and practically to implement any proposed changes. Since publication of the new guidance the document has become the subject of further discussion, following concerns raised by tissue viability nurse specialists with strategic responsibility for change, as well as generalists who are expected to implement the changes.
Source: Stephen-Haynes J. British Journal of Nursing, Nov 2024; 33(20): S16 - S22
The past, the present and the future
Abstract: Somebody asked me recently how I decide what to write about in the Editorial for BJN's Tissue Viability Supplement. I took a moment to think and gave the briefest of answers. When I reflected on it and really took the time, challenging myself, I concluded that it was a cumulative process of my experience of the past, the present and the future.
Source: Stephen-Haynes J. British Journal of Nursing, Nov 2024; 33(20): S3 - S3
The complex interplay between mechanical forces, tissue response and individual susceptibility to pressure ulcers
Abstract: Objective: The most recent edition of the International Clinical Practice Guideline for the Prevention and Treatment of Pressure Ulcers/Injuries was released in 2019. Shortly after, in 2020, the first edition of the SECURE Prevention expert panel report, focusing on device-related pressure ulcers/injuries, was published as a special issue in the Journal of Wound Care. A second edition followed in 2022. This article presents a comprehensive summary of the current understanding of the causes of pressure ulcers/injuries (PU/Is) as detailed in these globally recognised consensus documents.
Method: The literature reviewed in this summary specifically addresses the impact of prolonged soft tissue deformations on the viability of cells and tissues in the context of PU/Is related to bodyweight or medical devices.
Results: Prolonged soft tissue deformations initially result in cell death and tissue damage on a microscopic scale, potentially leading to development of clinical PU/Is over time. That is, localised high tissue deformations or mechanical stress concentrations can cause microscopic damage within minutes, but it may take several hours of continued mechanical loading for this initial cell and tissue damage to become visible and clinically noticeable. Superficial tissue damage primarily stems from excessive shear loading on fragile or vulnerable skin. In contrast, deeper PU/Is, known as deep tissue injuries, typically arise from stress concentrations in soft tissues at body regions over sharp or curved bony prominences, or under stiff medical devices in prolonged contact with the skin.
Conclusion: This review promotes deeper understanding of the pathophysiology of PU/Is, indicating that their primary prevention should focus on alleviating the exposure of cells and tissues to stress concentrations. This goal can be achieved either by reducing the intensity of stress concentrations in soft tissues, or by decreasing the exposure time of soft tissues to such stress concentrations.
Source: Gefen A. Journal of Wound Care, Sep 2024; 33(9): 620 - 628
Challenges ahead
Abstract: Happy New Year! This is an election year: I wonder what it will bring? The world of tissue viability faces many challenges and questions. Finances will remain a big challenge, whatever the outcome of the election.
Source: Stephen-Haynes J. British Journal of Nursing, Feb 2024; 33(4): S3 - S3
Key issues in an election year
Abstract: A General Election is an opportunity. So important is the government to the delivery of the NHS that, as a nurse, the coverage will be compelling viewing and listening for me. The productivity of the NHS is under scrutiny and there can be no doubt that there is a need to deliver better outcomes for the people of the UK.
One important issue is the lack of a clear strategy on social care, which has led to a crisis that has impacted the NHS. This needs to be a priority. Another issue is patients waiting on trolleys. In 2023, 35 000 patients waited for 12 hours on hospital trolleys every month in England (Lee, 2024). Working in tissue viability, my concern, apart from people waiting in discomfort or pain, is that this poses a significant challenge to pressure ulcer prevention.
Source: Stephen-Haynes J. British Journal of Nursing, Jun 2024; 33(12): S3 - S3
At a glance: pressure injuries
Abstract: Pressure injuries, also known as pressure ulcers or ‘bed sores’, are caused by prolonged pressure on the skin and underlying tissues and are common in healthcare settings. They result from a variety of factors including pressure, moisture and friction, with a higher risk among older adults, post‑surgical patients and those with limited mobility or long‑term conditions. These injuries can extend hospital stays and significantly impact patient recovery and mortality risk. Prevention includes regular repositioning, the use of pressure‑relieving devices, skin care and nutritional support. The National Institute for Health and Care Excellence provides guidelines to mitigate these risks through systematic risk assessments and targeted interventions. Early detection and specialist care by a multidisciplinary team are crucial to improving patient outcomes. Consistent pplication of prevention strategies are needed to reduce incidence, improve patient care and alleviate the economic burden of thesex injuries on the NHS.
Source: Williams L. British Journal of Nursing, Nov 2024; 33(20): S24 - S30
Integration of the aSSKINg framework into the electronic patient record: a quality improvement project
Abstract: Assessment of pressure ulcer (PU) risk is important in clinical practice and the need to document it in the patient's record is paramount. Despite national and international guidelines highlighting the need to document PU risk, nursing documentation remains variable. The first article in this series discussed the evidence base underpinning the development of clinical guidelines for PUs, alongside the creation of bundle approach for PU prevention. The second article presented the results of a clinical audit exploring compliance against a PU prevention bundle (aSSKINg framework) in an adult community nursing setting in the South East of England. This final article in the series presents the results of a quality improvement project that involved a clinical audit following the implementation of the aSSKINg framework into the electronic patient record (EPR). The aim was to improve nursing documentation for patients with PU risk. The clinical audit was conducted in two parts, with a pilot phase running between 6 February 2023 and 15 April 2023. After the template implementation into the EPR, a follow-up audit was undertaken between 1 November 2023 and 31 January 2024. Overall compliance against the aSSKINg framework improved, especially the completion of the PURPOSE-T on the first visit, full skin assessment and repositioning advice. Following the pilot phase, the aSSKINg template was rolled out in a phased approach to the adult community nursing, enhanced care home matrons and urgent community response teams.
Source: Martin S. British Journal of Community Nursing, Dec 2024; 29(Sup12): S16 - S21
Using a prognostic medical device for early identification of pressure ulcers: protocol for study design
Abstract: Background: An objective, physiological measurement taken using a medical device may reduce the incidence of pressure ulcers through earlier detection of problems signs before visual signs appear. Research in this field is hampered by variations in clinical practice and patient-level confounders.
Aim: The authors outline key considerations for designing a protocol for a study to assess the efficacy and safety of a prognostic medical device in reducing pressure ulcer incidence in a hospital, including comparators, randomisation, sample size, ethics and practical issues.
Method: Key issues relating to methodology and ethics are considered alongside a theoretical protocol, which could support future researchers in wound care trials.
Source: Keltie K. British Journal of Nursing, Jun 2024; 33(12): S8 - S18
Tissue viability and care of malignant wounds in patients near the end of life
Abstract: Skin changes at the end of life are common and can be attributed to a variety of factors. These changes can impact the appearance, texture and overall health of the skin, and can affect the person's comfort and overall wellbeing. It is important for health professionals to address these skin issues by providing appropriate skin care, pain management and emotional support. This article, the third in a series on palliative and end-of-life care, discusses risk assessment and monitoring of pressure ulcers, caring for malignant wounds and the importance of individualised care in a multiprofessional team.
Source: Russell J. Nursing Times, Jul 2024; 120(8): 44-47
Q&A approach to lower limb and leg ulcer management
Abstract: Here, Georgina Ritchie, director of education, Accelerate CIC, explains why she and colleagues decided to write a book on lower limb and leg ulcer management using a Q&A approach in order to tease out and explore the most relevant themes in this area of practice. [...]along with the important chapters on clinical assessment and management, we bring critique and synthesis to public health and the social determinants of health and how they affect patients with lower limb conditions. Interventions aimed at early management of CVI include a spectrum of approaches, including recommendations for lifestyle changes such as weight loss, increased physical activity, promoting good skin care and hygiene, and compression therapy. Early identification and referral to an appropriate specialist team for a patient suspected of having an atypical leg ulcer is essential and can assist in preventing unnecessary wound deterioration, managing the symptoms effectively, decreasing the risk of complications and improving quality of life for the individual.
Source: Anonymous. Journal of Community Nursing, 2024; 38(3): 63-66
Contact the library for a copy of this article
Frailty and the ageing skin: understanding skin tears
Abstract: The impact of ageing on the body and its association with skin harm and frailty in relation to multimorbidity, comorbidity and polypharmacy is clearly described in the literature. The ageing population globally brings with it the challenge for healthcare professionals of managing individuals with increasingly complex and inter-related needs. This article considers ageing skin and skin tears within the context of frailty as a syndrome. It discusses what frailty is understood to be, how to recognise and assess for it, and how to consider risk and prevention of harm to the skin of the ageing person with frailty.
Source: Sandoz H. Journal of Communty Nursing, Oct 2024; 38(5): 20-22, 24-26
Contact the library for a copy of this article
Content of a wound care mobile application for newly graduated nurses: an e-Delphi study
Abstract: Background: Wound care represents a considerable challenge, especially for newly graduated nurses. The development of a mobile application is envisioned to improve knowledge transfer and facilitate evidence-based practice. The aim of this study was to establish expert consensus on the initial content of the algorithm for a wound care mobile application for newly graduated nurses.
Methods: Experts participated in online surveys conducted in three rounds. Twenty-nine expert wound care nurses participated in the first round, and 25 participated in the two subsequent rounds. The first round, which was qualitative, included a mandatory open-ended question solicitating suggestions for items to be included in the mobile application. The responses underwent content analysis. The subsequent two rounds were quantitative, with experts being asked to rate their level of agreement on a 5-point Likert scale. These rounds were carried out iteratively, allowing experts to review their responses and see anonymized results from the previous round. We calculated the weighted kappa to determine the individual stability of responses within-subjects between the quantitative rounds. A consensus threshold of 80% was predetermined.
Results: In total, 80 items were divided into 6 categories based on the results of the first round. Of these, 75 (93.75%) achieved consensus during the two subsequent rounds. Notably, 5 items (6.25%) did not reach consensus. The items with the highest consensus related to the signs and symptoms of infection, pressure ulcers, and the essential elements for healing. Conversely, items such as toe pressure measurement, wounds around drains, and frostbite failed to achieve consensus.
Conclusions: The results of this study will inform the development of the initial content of the algorithm for a wound care mobile application. Expert participation and their insights on infection-related matters have the potential to support evidence-based wound care practice. Ongoing debates surround items without consensus. Finally, this study establishes expert wound care nurses’ perspectives on the competencies anticipated from newly graduated nurses.
Source: Gagnon J. BMC Nursing, May 2024; 23: 331
Managing hypergranulation in wounds
Abstract: Normal wound healing follows four distinct phases: haemostasis, inflammation, proliferation and finally, maturation. If any barriers to healing occur within these four phases, the healing process will be delayed or may even stall (Mitchell, 2021). One of the common barriers to healing is hyper or overgranulation, or 'proud flesh'. Hypergranulated wounds can cause concern to both patients and healthcare professionals, and, although common in wound care, there is a limited evidence base and currently no guidelines for management. This article discusses the causes of hypergranulation, with suggestions on how it can be managed.
Source: Brown A. Journal of Community Nursing, Feb 2024; 38(1): 24-27
Contact the library for a copy of this article
Effectiveness of interventions to enhance shared decision‐making in wound care: A systematic review
Abstract: Aims: To explore the effectiveness of interventions to enhance patient participation in shared decision‐making in wound care and tissue viability.
Background: Caring for people living with a wound is complex due to interaction between wound healing, symptoms, psychological wellbeing and treatment effectiveness. To respond to this complexity, there has been recent emphasis on the importance of delivering patient centred wound care and shared decision‐making to personalise health care. However, little is known about the effectiveness of existing interventions to support shared decision‐making in wound care.
Design: Systematic review of interventional studies to enhance shared decision‐making in wound care or tissue viability. This was reported following the Preferred Reporting Items for Systematic Reviews and Meta‐Analysis (PRISMA) guidelines 2020.
Methods: Interventional primary research studies published in English up to January 2023 were included. Screening, data extraction and quality appraisal were undertaken independently by two authors.
Data Sources: Medline, EMBASE, Cochrane Central Register of Controlled Trails (trials database), CINAHL, British Nursing Index (BNI), WorldCat (thesis database), Scopus and registries of ongoing studies (ISRCTN registry and clinicaltrials.gov).
Results: 1063 abstracts were screened, and eight full‐text studies included. Findings indicate, interventions to support shared decision‐making are positively received. Goal or need setting components may assist knowledge transfer between patient and clinician, and could lower short term decisional conflict. However, generally findings within this study had very low certainty due to the inconsistencies in outcomes reported, and the variation and complexity of single and multiple interventions used.
Conclusions: Future research on shared decision‐making interventions in wound care should include the involvement of stakeholders and programme theory to underpin the interventions developed to consider the complexity of interventions.
Implications for the profession and patient care: Patients setting out their needs or goals and exploring patient questions are important and should be considered in clinical care.
Source: Clemett V J. Journal of Clinical Nursing, Apr 2024; 33(8): 2813-2828
Effectiveness of specialised support surface modes in preventing pressure injuries in intensive care: A systematic review and meta-analysis
Abstract: Background: Patients in intensive care units (ICU) are at an increased risk of pressure injuries. In ICUs, specialised support surfaces are an intervention often used to prevent pressure injuries. This systematic review and meta-analysis aimed to ascertain the effectiveness of different specialised support surface modes for preventing pressure injuries to adult ICU patients.
Methods: Ovid MEDLINE, Ovid Embase, EBSCO CINAHL, PEDro, Cochrane Library, Clinicaltrials.gov and eligible paper references were searched for appropriate studies. Studies were included if they investigated both dynamic support surface modes low-air-loss (LAL) and alternating pressure (AP), involved adult ICU patients (≥18 years old), and investigated pressure injury incidence. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Mixed Methods Appraisal Tool (MMAT) checklists were used for reporting and quality assessment. Risk ratios (RRs) with 95 % Confidence Intervals (CIs) were used to summarise pressure injury incidence. The pooled RR was calculated with the random-effects model using the Mantel-Haenszel method. Further secondary analysis examined length of stay (LoS) and severity of illness.
Results: The four included studies involved 3,308 patients. These studies were heterogeneous in design. When AP surface mode was compared with LAL surface mode, there was no significant difference in the occurrence of pressure injury (8.9 % versus 10.9 %, RR 0.64). Mattress mode also had no direct association with length of stay and severity of illness.
Conclusion: This systematic review and meta-analysis found no significant difference in the effectiveness of LAL and AP support surface modes in preventing pressure injuries in adult ICU patients.
Implications for clinical practice: Clinicians should remember that mattresses are just one element within strategies to prevent pressure injuries in ICUs. The equivocal findings of this systematic review highlight the complexity of preventing pressure injuries and underscore the importance of holistic nursing care.
Source: Lane B. Intensive and Critical Care Nursing, Aug 2024; 83: 103713
Contact the library for a copy of this article
Research topics on pressure injury prevention and measurement tools from 1997 to 2023: A bibliometric analysis using VOSviewer
Abstract: Objectives: To identify and visualize studies on pressure injuries in intensive care units, prevention of pressure injuries and measurement tools, and reveal the global trends in this field.
Research methodology/design: Descriptive and bibliometric analysis method study.
Setting: Data were obtained from the “Web of Science Core Collection” database on July 12th, 2023. For bibliometric data, the Web of Science database was searched with the keywords “intensive care unit,“ ”pressure injury,“ ”prevention,“ ”risk assessment tools,“ and critical care.” Performance analysis, scientific mapping, and bibliometric analyses were completed using the VOSviewer (1.6.15) software program for a total of 326 publications.
Main outcome measures: Publication, cluster, link and network map on pressure injury, prevention and risk measurement tools.
Results: As a result of the analysis, the most used keywords were “pressure injury,” “pressure ulcer,” “critical care,” “pressure ulcers,” “intensive care unit,” and “pressure injuries.” The journal with the highest number of publications (n = 55) was “Journal of Wound Ostomy Continence Nursing”, the highest number of articles (n = 47) was published in 2022, the most active institution was “Queensland University of Technology Qut” (20 articles), the country that published the most was the United States of America (171 articles), the institution that provided the most funding was the “National Institutes of Health NIH USA” (20 articles), and Cox J. was the author who published the most articles.
Conclusion: This study highlights popular fields of research in pressure injury prevention and risk measurement tools aimed at improving quality of care in intensive care units.
Implications for Clinical Practice: The bibliometric analysis method used in the study can lead nurses to conduct research to prevent pressure injuries in critical care patients and develop risk measurement tools to overcome deficiencies such as prevention tools and objective risk measurement tools in this field.
Source: Azizoğlu F. Intensive & Critical Care Nursing, Feb 2024; 80: 103557
Introducing playing games and a fun element to help deliver wound care education
Abstract: According to Tamara Chilver, author and home-schooling mum: "fun + learning = the best educational experience." This article describes how the tissue viability team in Glasgow set about introducing a fun element into wound care education. The article also includes practical guidance on some of the games played by delegates at the education sessions.
Source: Hodgson H. Wounds UK, 2024; 20(4): 72-75
Contact the library for a copy of this article
Integrated lymphoedema and tissue viability service: improving patient and wound outcomes
Abstract: This article will focus on the integration of tissue viability and lymphoedema services to improve outcomes for patients with leg ulceration. It will highlight why there is a need for lymphoedema specialist knowledge within the care of patients with leg ulceration and how the services are closely aligned. Lymphoedema can adversely affect wound healing and the article will provide case studies that highlight how developing a hybrid tissue viability and lymphoedema clinician or integration of the specialists can provide effective patient-centred care at reduced cost. The article offers potential strategies and suggestions on how to address inequalities in care and how to improve service provision.
Source: Stanton J. British Journal of Community Nursing, Apr 2024; 29(Sup4); S19-S26
The utilisation of a negative pressure wound therapy clinical decision tree in an acute care setting tissue viability service
Abstract: The aim of this case series and service evaluation was to demonstrate the beneficial clinical and economic outcomes of the utilisation of a negative pressure wound therapy (NPWT) clinical decision tree within routine practice. A total of 16 retrospective anonymised complex wound case studies were referred to the tissue viability nursing (TVN) service. Patients received NPWT as inpatients, as per routine practice. Data was reported as an aggregated cohort, with further stratification by wound type. Descriptive statistics were utilised. The most prevalent wound type was dehisced surgical wounds (n=10; 62.5%) located on the abdomen (n=9; 56.25%). Risk of contamination (43.75%) and exudate management (43.75%) were the most common rationales for choosing traditional NPWT (tNPWT). Seven patients (43.75%) were discharged from hospital still requiring NPWT, with five (71.4%) having wound criteria suitable for single use NPWT (sNPWT). Using tNPWT and sNPWT alongside a clinical decision tree can assist in optimising NPWT delivery to patients within an acute care setting.
Source: Leek K. Journal of Wound Management, Apr 2024; 25(1): 2-9
Oxygen Saturation or Tissue Oxygen Determinations on Skin Whose Viability is at Risk
Abstract: The triad of ischaemia, neuropathy, and infection are among the principal causes of lower extremity wounds that are commonly prevalent in patients with diabetic foot (DF) a condition in which peripheral arterial disease commonly co-exists. The prevalence of this condition is increasing globally and with it, the mounting costs of its management. One aspect of management is saving limbs and or digits, a crucial part of this process is assessing tissue viability of skin which is a focus of this review: there are other aspects which are well described in the literature. Amputations are offered to limit the damage resulting from acute/chronic ischaemia. Holstein measured skin perfusion pressure using a radioisotope clearance technique to describe critically ischaemic skin; he found 30 mm Hg as the threshold above which healing may reliably be expected. Recent advances in vascular surgery and related technology have informed evidence-based advice to revascularize and save limbs; in practice, this may leave a wound in the distal skin unhealed; managing these raises questions of tissue viability. Much effort has been made to manage, prevent and to better understand these lower extremity wounds using measurements of tissue oxygen, oxygen saturation and skin imaging. The measurement techniques and their relevant merits are examined in this article. Advances in wound management systems and protocols can also facilitate the repair processes, and those which can have a particular impact on restoring or maintaining tissue perfusion are also discussed in the article.
Source: Richardson M. International journal of Lower Extremity Wounds, 2024; Mar 23(1): 55-62
Contact the library for a copy of this article
Sharing the journey ... of setting up a Tissue Viability Service in NHS Tayside: the first year
Abstract: Last year’s Wounds Scotland conference saw a number of healthcare professionals share their journey of implementing changes to the way we deliver healthcare. Here, Jane Nicoll describes setting a new tissue viability service.
Source: Nicoll J. Wounds UK, Feb 2024; 20(1): 25-26
Friday, December 13, 2024
Thursday, November 7, 2024
Advanced Clinical Practice: November 2024
Welcome to the latest key papers and publications focussing mainly on advanced clinical practice in the nursing profession.
Please click on the links below and enter your OpenAthens username and password to download the full text or contact the library at esth.hirsonlibrary@nhs.net to request the full text.
Exploring advanced clinical practitioner perspectives on training, role identity and competence: a qualitative study
Abstract:
Background: Advanced Clinical Practitioners (ACPs) are a new role that have been established to address gaps and support the existing medical workforce in an effort to help reduce increasing pressures on NHS services. ACPs have the potential to practice at a similar level to mid-grade medical staff, for example independently undertaking assessments, requesting and interpreting investigations, and diagnosing and discharging patients. These roles have been shown to improve both service outcomes and quality of patient care. However, there is currently no widespread formalised standard of training within the UK resulting in variations in the training experiences and clinical capabilities of ACPs. We sought to explore the training experiences of ACPs as well as their views on role identity and future development of the role.
Methods: Five online focus groups were conducted between March and May 2021 with trainee and qualified advanced clinical practitioners working in a range of healthcare settings, in the North of England. The focus groups aimed to explore the experiences of undertaking ACP training including supervision, gaining competence, role identity and career progression. Thematic analysis of the focus group transcripts was performed, informed by grounded theory principles.
Results: Fourteen advanced clinical practitioners participated. Analysis revealed that training was influenced by internal and external perceptions of the role, often acting as barriers, with structural aspects being significant contributory factors. Key themes identified (1) clinical training lacked structure and support, negatively impacting progress, (2) existing knowledge and experience acted as both an enabler and inhibitor, with implications for confidence, (3) the role and responsibilities are poorly understood by both advanced clinical practitioners and the wider medical profession and (4) advanced clinical practitioners recognised the value and importance of the role but felt changes were necessary, to provide security and sustainability.
Conclusions: Appropriate structure and support are crucial throughout the training process to enable staff to have a smooth transition to advanced level, ensuring they obtain the necessary confidence and competence. Structural changes and knowledge brokering are essential, particularly in relation to role clarity and its responsibilities, sufficient allocated time to learn and practice, role accreditation and continuous appropriate supervision.
Source: Kuczawski M. BMC Nursing, 2024; 23(1): 185
Working in primary care: an advanced clinical practitioner's perspective
Abstract: Primary care has often been negatively represented in the media, potentially adding to the notion that this is not an interesting or attractive place to work. I would like to give an honest opinion from my own experience of working within the primary care sector as a nurse and an advanced clinical practitioner (ACP).
Source: Coaten Josey M. British Journal of Nursing, 2024; 33(2): 90
A qualitative study exploring the experiences of advanced clinical practitioner training in emergency care in the South West of England, United Kingdom
Abstract:
Background: Attempting to improve emergency care (EC) advanced clinical practitioner (ACP) training, Health Education England (HEE) South West (SW) implemented a pilot, whereby emergency departments (ED) were provided with enhanced funding and support to help ED consultants deliver teaching and supervision to EC ACPs to ensure more timely completion of EC ACP training compared with previous cohorts training in the region.
We explored the experiences of trainee EC ACPs and consultant EC ACP leads working in EDs, which had implemented the new regional pilot.
Methods: We used a qualitative design to conduct semi-structured interviews with trainee EC ACPs and consultant EC ACP leads across five EDs that had implemented the HEE SW pilot. Interview data were analysed thematically.
Results: Twenty-five people were interviewed. We identified four themes: (1) the master’s in advanced practice could be better aligned with the Royal College of Emergency Medicine credentialling e-portfolio; (2) EC ACP training needs some flexibility to reflect the individual—‘one size does not fit all’; (3) supervision and teaching were recognised as important but requires significant staff capacity that is impacted by external pressures and (4) unclear role expectations and responsibilities hinder role transition and impact role identity.
It was notable that EC ACPs primarily spoke about the development of their clinical skills both academically and within the workplace, despite there being other skills mentioned in the multiprofessional framework for advanced practice (leadership and management, education and research).
Conclusion: A clear supervision structure with protected time allocated for teaching and assessment of clinical skills within the ED is essential to facilitate trainee EC ACP progression. However, increasing demands on EDs make this a challenging goal to achieve. Role identity issues continue to persist despite the introduction of new guidance designed to provide more clarity around the ACP role.
Source: Ablard S. Emergency Medicine Journal, 2024; 0: 1-7
Research strategies for trainee and qualified advanced clinical practitioners that enhance evidence-based practice
Abstract: Advanced clinical practitioners (ACPs) are integral to modern healthcare, providing high-quality, evidence-based care to patients. While ACPs show some development in clinical practice, leadership, and education, challenges persist in the research pillar. Trainee and qualified ACPs often have difficulties initiating their research journey and may feel uncertain about where to start. Existing studies have explored and emphasised the importance of ACPs developing and maintaining their research skills, yet there remains a gap in understanding how they can effectively demonstrate their research capabilities. Therefore, this article aims to help trainees and qualified ACPs on how to evidence their research pillar capabilities.
Source: Alsararatee Hasan H. British Journal of Nursing, 2024; 33(14): 663-665
What is nursing in advanced nursing practice? Applying theories and models to advanced nursing practice-A discursive review
Abstract:
Aim: This article appraises models and theories related to advanced nursing practice. It argues that while the role of the advanced nurse practitioner builds on and extends beyond traditional nursing, it remains firmly grounded in 'caring'.
Background: The stereotype that nurses 'care' and doctors 'cure' is fading. Increasingly, nurses have crossed boundaries and conducted independent assessment, diagnosis, prescribing and consultation, which used to be the doctor's role. Confusion and argument have arisen due to the higher-level practice of the advanced nurse practitioner, as many questions where these 'doctor nurses' stand.
Design: A literature review.
Data sources: Databases, including CINAHL, Medline and Google Scholar, were searched.
Method: Databases were searched, and relevant studies and review articles from 1970 to 2023 were identified using the following keywords: 'advanced nurse practitioner', 'nurse practitioner', 'advanced nursing', 'advance practice', 'nurse practitioner', 'nursing theory' and 'nursing model'.
Results: Although advanced nurse practitioners identify themselves as nurses, there is limited use of nursing theory to conceptualize this new level of practice and to define their contribution to the multi-disciplinary team. It is noted that a holistic approach to personalized patient care, based on therapeutic relationships and effective communication, may help us identify the unique contribution of the advanced nurse practitioner.
Conclusions: The development of advanced nursing theory needs to capture this holistic approach and its caring element to recognize the value and strengthen the identity allegiance of this hybrid role.
Implications for the profession and/or patient care: Holistic approach and patient-centred care, effective communication and the therapeutic relationship are strong characteristics relating to ANP practice, the latter of which is yet to be clearly defined and captured in nursing theories. Conceptualizing ANP practice and capturing their valuable nursing care will enable better understanding and clarity for the role to realize its full potential.
Source: Zhang Y. Journal of Advanced Nursing, 2024; Online ahead of print
Validation of the newly developed Advanced Practice Nurse Task Questionnaire: A national survey
Abstract:
Aim: To describe psychometric validation of the newly developed Advanced Practice Nurse Task Questionnaire.
Design: Cross-sectional quantitative study.
Methods: The development of the questionnaire followed an adapted version of the seven steps described in the guide by the Association for Medical Education in Europe. A nationwide online survey tested the construct and structural validity and internal consistency using an exploratory factor analysis, Cronbach's alpha coefficient and a Kruskal-Wallis test to compare the hypotheses.
Results: We received 222 questionnaires between January and September 2020. The factor analysis produced a seven-factor solution as suggested in Hamric's model. However, not all item loadings aligned with the framework's competencies. Cronbach's alpha of factors ranged between .795 and .879. The analysis confirmed the construct validity of the Advanced Practice Nurse Task Questionnaire. The tool was able to discriminate the competencies of guidance and coaching, direct clinical practice and leadership across the three advanced practice nurse roles clinical nurse specialist, nurse practitioner or blended role.
Conclusion: A precise assessment of advanced practice nurse tasks is crucial in clinical practice and in research as it may be a basis for further refinement, implementation and evaluation of roles.
Impact: The Advanced Practice Nurse Task Questionnaire is the first valid tool to assess tasks according to Hamric's model of competencies independently of the role or the setting. Additionally, it distinguishes the most common advanced practice nurse roles according to the degree of tasks in direct clinical practice and leadership. The tool may be applied in various countries, independent of the degree of implementation and understanding of advanced nursing practice.
Reporting method: The STARD 2015 guideline was used to report the study.
Patient or public contribution: No patient or public contribution.
Source: Beckmann S. Journal of Advanced Nursing, 2023; 79(12): 4791-4803
Factors Influencing the impact of nurse practitioners’ clinical autonomy: a self determining perspective
Abstract:
Aim: To explore factors that influence the impact of nurse practitioners' clinical autonomy with a self-determining perspective.
Background: Worldwide, there is a significant demand for healthcare professionals such as the nurse practitioner in meeting some healthcare needs across patients' lifespans. Factors influencing nurse practitioners clinical autonomy can impact the full utilisation of the role in practice.
Introduction: Limited evidence exists that describes or researches nurse practitioner clinical autonomy. Instead, there is a focus in the literature on strategic debates, role confusion and nurse practitioners reporting the straddling between nursing, allied heath professionals and medicine in the provision of healthcare services.
Design: A cross-sectional study design was used in a purposive sample in a national sample of nurse practitioners in Ireland across a full range of healthcare settings. Additionally, the survey included open comments sections to capture qualitative comments by the nurse practitioners themselves.
Methods: Self-determination theory is rooted in an organismic dialectical stance. This study used a convenience sample of n = 148 from a total sample of n = 448 (33%) of the population. The Dempster Practice Behavioural Scale and an initially validated advanced nursing practice clinical autonomy scale were used. Open comments were analysed by thematic analysis. STROBE Standards guidelines for cross-sectional studies were followed, and COREQ guidelines were followed for writing qualitative research.
Results: The study findings demonstrated that the more clinical experience the nurse practitioner had, the higher their levels of clinical autonomy. The previous length of nursing experience did not impact nurse practitioner clinical autonomy levels. However, average experience of nurse practitioner' in this study was 3-10 years. No significant differences existed between the reported gender, nurse practitioners' clinical autonomy and decision-making. 1:40 female and 1:9 male nurse practitioners undertook a doctorate or PhD-level education. No advanced nurse practitioner identified as non-binary. Gender and organisational culture considerations can influence nurse practitioners clinical autonomy.
Implications for nursing and health policy: This study highlights intrinsic motivators that support nurse practitioners in providing innovative healthcare: competence, relatedness and clinical autonomy. Countries credentialing, regulations professional standards and healthcare policy positively influence nurse practitioner clinical autonomy. Nurse practitioners' clinical autonomy is championed when health policy and organisational stakeholders intrinsically collaborate. A disconnect between health policy organisational culture extrinsically influences lower levels of nurse practitioners' clinical autonomy.
Conclusion: The findings underline the positive impact of nurse practitioner clinical autonomy. A recommendation of this study is to continue to measure impact of clinical autonomy and develop nurse practitioners' self-determination strategies around the role and integrity of their levels of intrinsic clinical autonomy.
Please click on the links below and enter your OpenAthens username and password to download the full text or contact the library at esth.hirsonlibrary@nhs.net to request the full text.
Exploring advanced clinical practitioner perspectives on training, role identity and competence: a qualitative study
Abstract:
Background: Advanced Clinical Practitioners (ACPs) are a new role that have been established to address gaps and support the existing medical workforce in an effort to help reduce increasing pressures on NHS services. ACPs have the potential to practice at a similar level to mid-grade medical staff, for example independently undertaking assessments, requesting and interpreting investigations, and diagnosing and discharging patients. These roles have been shown to improve both service outcomes and quality of patient care. However, there is currently no widespread formalised standard of training within the UK resulting in variations in the training experiences and clinical capabilities of ACPs. We sought to explore the training experiences of ACPs as well as their views on role identity and future development of the role.
Methods: Five online focus groups were conducted between March and May 2021 with trainee and qualified advanced clinical practitioners working in a range of healthcare settings, in the North of England. The focus groups aimed to explore the experiences of undertaking ACP training including supervision, gaining competence, role identity and career progression. Thematic analysis of the focus group transcripts was performed, informed by grounded theory principles.
Results: Fourteen advanced clinical practitioners participated. Analysis revealed that training was influenced by internal and external perceptions of the role, often acting as barriers, with structural aspects being significant contributory factors. Key themes identified (1) clinical training lacked structure and support, negatively impacting progress, (2) existing knowledge and experience acted as both an enabler and inhibitor, with implications for confidence, (3) the role and responsibilities are poorly understood by both advanced clinical practitioners and the wider medical profession and (4) advanced clinical practitioners recognised the value and importance of the role but felt changes were necessary, to provide security and sustainability.
Conclusions: Appropriate structure and support are crucial throughout the training process to enable staff to have a smooth transition to advanced level, ensuring they obtain the necessary confidence and competence. Structural changes and knowledge brokering are essential, particularly in relation to role clarity and its responsibilities, sufficient allocated time to learn and practice, role accreditation and continuous appropriate supervision.
Source: Kuczawski M. BMC Nursing, 2024; 23(1): 185
Working in primary care: an advanced clinical practitioner's perspective
Abstract: Primary care has often been negatively represented in the media, potentially adding to the notion that this is not an interesting or attractive place to work. I would like to give an honest opinion from my own experience of working within the primary care sector as a nurse and an advanced clinical practitioner (ACP).
Source: Coaten Josey M. British Journal of Nursing, 2024; 33(2): 90
A qualitative study exploring the experiences of advanced clinical practitioner training in emergency care in the South West of England, United Kingdom
Abstract:
Background: Attempting to improve emergency care (EC) advanced clinical practitioner (ACP) training, Health Education England (HEE) South West (SW) implemented a pilot, whereby emergency departments (ED) were provided with enhanced funding and support to help ED consultants deliver teaching and supervision to EC ACPs to ensure more timely completion of EC ACP training compared with previous cohorts training in the region.
We explored the experiences of trainee EC ACPs and consultant EC ACP leads working in EDs, which had implemented the new regional pilot.
Methods: We used a qualitative design to conduct semi-structured interviews with trainee EC ACPs and consultant EC ACP leads across five EDs that had implemented the HEE SW pilot. Interview data were analysed thematically.
Results: Twenty-five people were interviewed. We identified four themes: (1) the master’s in advanced practice could be better aligned with the Royal College of Emergency Medicine credentialling e-portfolio; (2) EC ACP training needs some flexibility to reflect the individual—‘one size does not fit all’; (3) supervision and teaching were recognised as important but requires significant staff capacity that is impacted by external pressures and (4) unclear role expectations and responsibilities hinder role transition and impact role identity.
It was notable that EC ACPs primarily spoke about the development of their clinical skills both academically and within the workplace, despite there being other skills mentioned in the multiprofessional framework for advanced practice (leadership and management, education and research).
Conclusion: A clear supervision structure with protected time allocated for teaching and assessment of clinical skills within the ED is essential to facilitate trainee EC ACP progression. However, increasing demands on EDs make this a challenging goal to achieve. Role identity issues continue to persist despite the introduction of new guidance designed to provide more clarity around the ACP role.
Source: Ablard S. Emergency Medicine Journal, 2024; 0: 1-7
Research strategies for trainee and qualified advanced clinical practitioners that enhance evidence-based practice
Abstract: Advanced clinical practitioners (ACPs) are integral to modern healthcare, providing high-quality, evidence-based care to patients. While ACPs show some development in clinical practice, leadership, and education, challenges persist in the research pillar. Trainee and qualified ACPs often have difficulties initiating their research journey and may feel uncertain about where to start. Existing studies have explored and emphasised the importance of ACPs developing and maintaining their research skills, yet there remains a gap in understanding how they can effectively demonstrate their research capabilities. Therefore, this article aims to help trainees and qualified ACPs on how to evidence their research pillar capabilities.
Source: Alsararatee Hasan H. British Journal of Nursing, 2024; 33(14): 663-665
What is nursing in advanced nursing practice? Applying theories and models to advanced nursing practice-A discursive review
Abstract:
Aim: This article appraises models and theories related to advanced nursing practice. It argues that while the role of the advanced nurse practitioner builds on and extends beyond traditional nursing, it remains firmly grounded in 'caring'.
Background: The stereotype that nurses 'care' and doctors 'cure' is fading. Increasingly, nurses have crossed boundaries and conducted independent assessment, diagnosis, prescribing and consultation, which used to be the doctor's role. Confusion and argument have arisen due to the higher-level practice of the advanced nurse practitioner, as many questions where these 'doctor nurses' stand.
Design: A literature review.
Data sources: Databases, including CINAHL, Medline and Google Scholar, were searched.
Method: Databases were searched, and relevant studies and review articles from 1970 to 2023 were identified using the following keywords: 'advanced nurse practitioner', 'nurse practitioner', 'advanced nursing', 'advance practice', 'nurse practitioner', 'nursing theory' and 'nursing model'.
Results: Although advanced nurse practitioners identify themselves as nurses, there is limited use of nursing theory to conceptualize this new level of practice and to define their contribution to the multi-disciplinary team. It is noted that a holistic approach to personalized patient care, based on therapeutic relationships and effective communication, may help us identify the unique contribution of the advanced nurse practitioner.
Conclusions: The development of advanced nursing theory needs to capture this holistic approach and its caring element to recognize the value and strengthen the identity allegiance of this hybrid role.
Implications for the profession and/or patient care: Holistic approach and patient-centred care, effective communication and the therapeutic relationship are strong characteristics relating to ANP practice, the latter of which is yet to be clearly defined and captured in nursing theories. Conceptualizing ANP practice and capturing their valuable nursing care will enable better understanding and clarity for the role to realize its full potential.
Source: Zhang Y. Journal of Advanced Nursing, 2024; Online ahead of print
Validation of the newly developed Advanced Practice Nurse Task Questionnaire: A national survey
Abstract:
Aim: To describe psychometric validation of the newly developed Advanced Practice Nurse Task Questionnaire.
Design: Cross-sectional quantitative study.
Methods: The development of the questionnaire followed an adapted version of the seven steps described in the guide by the Association for Medical Education in Europe. A nationwide online survey tested the construct and structural validity and internal consistency using an exploratory factor analysis, Cronbach's alpha coefficient and a Kruskal-Wallis test to compare the hypotheses.
Results: We received 222 questionnaires between January and September 2020. The factor analysis produced a seven-factor solution as suggested in Hamric's model. However, not all item loadings aligned with the framework's competencies. Cronbach's alpha of factors ranged between .795 and .879. The analysis confirmed the construct validity of the Advanced Practice Nurse Task Questionnaire. The tool was able to discriminate the competencies of guidance and coaching, direct clinical practice and leadership across the three advanced practice nurse roles clinical nurse specialist, nurse practitioner or blended role.
Conclusion: A precise assessment of advanced practice nurse tasks is crucial in clinical practice and in research as it may be a basis for further refinement, implementation and evaluation of roles.
Impact: The Advanced Practice Nurse Task Questionnaire is the first valid tool to assess tasks according to Hamric's model of competencies independently of the role or the setting. Additionally, it distinguishes the most common advanced practice nurse roles according to the degree of tasks in direct clinical practice and leadership. The tool may be applied in various countries, independent of the degree of implementation and understanding of advanced nursing practice.
Reporting method: The STARD 2015 guideline was used to report the study.
Patient or public contribution: No patient or public contribution.
Source: Beckmann S. Journal of Advanced Nursing, 2023; 79(12): 4791-4803
Factors Influencing the impact of nurse practitioners’ clinical autonomy: a self determining perspective
Abstract:
Aim: To explore factors that influence the impact of nurse practitioners' clinical autonomy with a self-determining perspective.
Background: Worldwide, there is a significant demand for healthcare professionals such as the nurse practitioner in meeting some healthcare needs across patients' lifespans. Factors influencing nurse practitioners clinical autonomy can impact the full utilisation of the role in practice.
Introduction: Limited evidence exists that describes or researches nurse practitioner clinical autonomy. Instead, there is a focus in the literature on strategic debates, role confusion and nurse practitioners reporting the straddling between nursing, allied heath professionals and medicine in the provision of healthcare services.
Design: A cross-sectional study design was used in a purposive sample in a national sample of nurse practitioners in Ireland across a full range of healthcare settings. Additionally, the survey included open comments sections to capture qualitative comments by the nurse practitioners themselves.
Methods: Self-determination theory is rooted in an organismic dialectical stance. This study used a convenience sample of n = 148 from a total sample of n = 448 (33%) of the population. The Dempster Practice Behavioural Scale and an initially validated advanced nursing practice clinical autonomy scale were used. Open comments were analysed by thematic analysis. STROBE Standards guidelines for cross-sectional studies were followed, and COREQ guidelines were followed for writing qualitative research.
Results: The study findings demonstrated that the more clinical experience the nurse practitioner had, the higher their levels of clinical autonomy. The previous length of nursing experience did not impact nurse practitioner clinical autonomy levels. However, average experience of nurse practitioner' in this study was 3-10 years. No significant differences existed between the reported gender, nurse practitioners' clinical autonomy and decision-making. 1:40 female and 1:9 male nurse practitioners undertook a doctorate or PhD-level education. No advanced nurse practitioner identified as non-binary. Gender and organisational culture considerations can influence nurse practitioners clinical autonomy.
Implications for nursing and health policy: This study highlights intrinsic motivators that support nurse practitioners in providing innovative healthcare: competence, relatedness and clinical autonomy. Countries credentialing, regulations professional standards and healthcare policy positively influence nurse practitioner clinical autonomy. Nurse practitioners' clinical autonomy is championed when health policy and organisational stakeholders intrinsically collaborate. A disconnect between health policy organisational culture extrinsically influences lower levels of nurse practitioners' clinical autonomy.
Conclusion: The findings underline the positive impact of nurse practitioner clinical autonomy. A recommendation of this study is to continue to measure impact of clinical autonomy and develop nurse practitioners' self-determination strategies around the role and integrity of their levels of intrinsic clinical autonomy.
Source: Lockwood Emily B. International Nursing Review, 2024; 71(2): 375-395
Supporting Advanced Practice Nursing Clinical Instructors with a Multimedia Guidebook
Abstract: Clinical instructors (CIs) in advanced practice nursing need to be competent clinicians and educators and understand the academic programs and clinical processes. CIs were asked to interact with an evidence-based multimedia guidebook and complete a survey to measure their acquisition of knowledge after the interaction. Response to the survey was 41.6%. Most CIs scored ≥83% on the knowledge acquisition survey. The findings support the use of a multimedia guidebook to support CI knowledge in the educator role and highlight the need for continued CI training and mentorship.
Source: Montejo L. The Journal of Nurse Practitioners, 2024; 20(5): 104969
Contact the library for a copy of this article
Continuing education for advanced practice nurses: A scoping review
Abstract:
Aim: The aim of the study was to identify the nature and extent of scientific research addressing continuing education for advanced practice nurses.
Design: A scoping review.
Review methods: The Joanna Briggs Institute's methodology for scoping reviews.
Data sources: Electronic search was conducted on 17 September 2023 via CINAHL, PsycINFO, PubMed, Scopus, Web of Science, Cochrane Library and the Joanna Briggs Institute's Evidence-Based Practice Database for research articles published between 2012 and 2023.
Results: Nineteen papers were included in this review. Scientific research on continuing education for advanced practice nursing roles (i.e. nurse practitioner, clinical nurse specialist) has primarily been conducted in the United States and mostly addresses online-delivered continuing education interventions for clinical care competency. Most of the interventions targeted nurse practitioners.
Conclusion: Continuing education has a pivotal role in supporting advanced practice nursing competency development. In addition to clinical care, future continuing education research should focus on other advanced practice nursing competencies, such as education, leadership, supporting organizational strategies, research and evidence implementation.
Implications for the profession and/or patient care: Continuing education programmes for advanced practice nurses should be rigorously developed, implemented and evaluated to support the quality and effectiveness of patient care.
Impact: Continuing education for advanced practice nursing roles is an understudied phenomenon. This review highlights future research priorities and may inform the development of continuing education programmes.
Reporting method: PRISMA-ScR.
Source: Wright Mea Mirella Marjatta. Journal of Advanced Nursing, 2024; 80(8): 3037-3058
History taking for advanced clinical practitioners: what should you ask?
Abstract: Good history taking is a vital component of patient assessment and high-quality care. This second article in our assessment and interpretation series for advanced nurse or midwife practitioners shows how a systematic approach to taking a history, combined with asking patients about their ideas, concerns and expectations, gives a thorough understanding of patients’ complaints and priorities.
Source: Butler S. Nursing Times, 2024; 120(3): 1-4
Senior Nurse Manager Perceptions of Nurse Practitioner Integration: A Quantitative Study
Abstract:
Supporting Advanced Practice Nursing Clinical Instructors with a Multimedia Guidebook
Abstract: Clinical instructors (CIs) in advanced practice nursing need to be competent clinicians and educators and understand the academic programs and clinical processes. CIs were asked to interact with an evidence-based multimedia guidebook and complete a survey to measure their acquisition of knowledge after the interaction. Response to the survey was 41.6%. Most CIs scored ≥83% on the knowledge acquisition survey. The findings support the use of a multimedia guidebook to support CI knowledge in the educator role and highlight the need for continued CI training and mentorship.
Source: Montejo L. The Journal of Nurse Practitioners, 2024; 20(5): 104969
Contact the library for a copy of this article
Continuing education for advanced practice nurses: A scoping review
Abstract:
Aim: The aim of the study was to identify the nature and extent of scientific research addressing continuing education for advanced practice nurses.
Design: A scoping review.
Review methods: The Joanna Briggs Institute's methodology for scoping reviews.
Data sources: Electronic search was conducted on 17 September 2023 via CINAHL, PsycINFO, PubMed, Scopus, Web of Science, Cochrane Library and the Joanna Briggs Institute's Evidence-Based Practice Database for research articles published between 2012 and 2023.
Results: Nineteen papers were included in this review. Scientific research on continuing education for advanced practice nursing roles (i.e. nurse practitioner, clinical nurse specialist) has primarily been conducted in the United States and mostly addresses online-delivered continuing education interventions for clinical care competency. Most of the interventions targeted nurse practitioners.
Conclusion: Continuing education has a pivotal role in supporting advanced practice nursing competency development. In addition to clinical care, future continuing education research should focus on other advanced practice nursing competencies, such as education, leadership, supporting organizational strategies, research and evidence implementation.
Implications for the profession and/or patient care: Continuing education programmes for advanced practice nurses should be rigorously developed, implemented and evaluated to support the quality and effectiveness of patient care.
Impact: Continuing education for advanced practice nursing roles is an understudied phenomenon. This review highlights future research priorities and may inform the development of continuing education programmes.
Reporting method: PRISMA-ScR.
Source: Wright Mea Mirella Marjatta. Journal of Advanced Nursing, 2024; 80(8): 3037-3058
History taking for advanced clinical practitioners: what should you ask?
Abstract: Good history taking is a vital component of patient assessment and high-quality care. This second article in our assessment and interpretation series for advanced nurse or midwife practitioners shows how a systematic approach to taking a history, combined with asking patients about their ideas, concerns and expectations, gives a thorough understanding of patients’ complaints and priorities.
Source: Butler S. Nursing Times, 2024; 120(3): 1-4
Senior Nurse Manager Perceptions of Nurse Practitioner Integration: A Quantitative Study
Abstract:
Aim. To determine Senior Nurse Managers’ perceptions of integration of Nurse Practitioner roles in Healthcare Organisations across Ireland and Australia. Background. Introduction of the Nurse Practitioner role in both countries is well established with national policies aimed at developing a critical mass in the health workforce. Current policy requires Senior Nurse Managers to be actively involved in the introduction of and oversight of the integration of Nurse Practitioners across healthcare settings. This is integral in the context of the success and sustainability of the services provided by the Nurse Practitioner. Methods. A quantitative, cross-sectional cloud-based survey of senior nurse managers across Ireland and Australia from April to September 2022. Results. Of 300 responses received, 122 were eligible for analysis. Of these, 77% expressed that there should be a specific role to support the integration of Nurse Practitioner roles at local level, and 61% recommended that this should occur at a national level, whilst 48% reported the absence of a standardised governance structure. Three reporting structures were identified: professional, clinical, and operational. Autonomous clinical decision making and prescribing were two Nurse Practitioner functions most identified. Fifty-five percent reported having performance indicators for Nurse Practitioner roles, with 24% agreeing that performance indicators captured the quality of care provided. Thirty-five percent of senior nurse managers indicated that there were agreed reporting timelines for performance indicators and a requirement for the provision of an annual report. Conclusion. Whilst some participants reported structure to guide and evaluate the work and value of Nurse Practitioners, the approach was inconsistent across organisations and countries. This paper demonstrates that integration is not broadly established across both countries. Implications for the Profession. The main findings were that Nurse Practitioners were misunderstood and the development of a structured framework to support the integration of Nurse Practitioners would provide long-term benefits.
Source: Ryder M. Journal of Nursing Management, 2024
Advanced nurse and midwife practitioners' experience of interprofessional collaboration when implementing evidence‐based practice into routine care: An interpretative phenomenological analysis
Abstract:
Source: Ryder M. Journal of Nursing Management, 2024
Advanced nurse and midwife practitioners' experience of interprofessional collaboration when implementing evidence‐based practice into routine care: An interpretative phenomenological analysis
Abstract:
Aim: To understand advanced nurse and midwife practitioners' experience of interprofessional collaboration in implementing evidence-based practice into routine care.
Design: A qualitative interpretative phenomenological analysis.
Methods: A purposeful sample of 10 Registered Advanced Nurse and Midwife Practitioners from a range of practice settings in the Republic of Ireland participated in semi-structured interviews over a 10-month timeframe. Interviews were transcribed verbatim and data were analysed using a multi-stage approach in line with guidance for interpretative phenomenological analysis.
Results: Six superordinate themes emerged: Understanding of advanced practice; 'Treated as an equal and as a "nurse"'; Nursing management support; 'A voice to implement anything new'; Confidence and Emotional intelligence. These factors impacted interprofessional relationships and the extent to which advanced practitioners could implement evidence-based practice.
Conclusion: There is scope to improve advanced practitioners' ability to collaborate with the interprofessional team in implementing evidence-based practice into routine care.
Impact and implications: The study findings demonstrate that enhancing understanding of the advanced practice role; increasing organizational support for advanced practitioners and augmenting specific practitioner skills and attributes will increase their ability to collaborate effectively and implement evidence-based practice. Supporting advanced practitioners in this important aspect of their role will positively influence health outcomes for patients.
Contribution to the wider global clinical community: As numbers of both nurse and midwife practitioners increase globally, this study provides timely evidence from a range of practice settings to guide the design of education programmes and policies governing advanced practice. Study recommendations have broad applicability to all healthcare professionals who are engaged in implementing evidence-based practice into routine care.
Reporting method: Consolidated criteria for reporting qualitative research (COREQ).
Patient or public contribution: No patient or public contribution.
Source: Clarke V. Journal of Advanced Nursing, 2024; 80(4): 1559-1573
Advanced nurse practitioner well‐being: A 4‐year cohort mixed methods study
Abstract:
Design: A qualitative interpretative phenomenological analysis.
Methods: A purposeful sample of 10 Registered Advanced Nurse and Midwife Practitioners from a range of practice settings in the Republic of Ireland participated in semi-structured interviews over a 10-month timeframe. Interviews were transcribed verbatim and data were analysed using a multi-stage approach in line with guidance for interpretative phenomenological analysis.
Results: Six superordinate themes emerged: Understanding of advanced practice; 'Treated as an equal and as a "nurse"'; Nursing management support; 'A voice to implement anything new'; Confidence and Emotional intelligence. These factors impacted interprofessional relationships and the extent to which advanced practitioners could implement evidence-based practice.
Conclusion: There is scope to improve advanced practitioners' ability to collaborate with the interprofessional team in implementing evidence-based practice into routine care.
Impact and implications: The study findings demonstrate that enhancing understanding of the advanced practice role; increasing organizational support for advanced practitioners and augmenting specific practitioner skills and attributes will increase their ability to collaborate effectively and implement evidence-based practice. Supporting advanced practitioners in this important aspect of their role will positively influence health outcomes for patients.
Contribution to the wider global clinical community: As numbers of both nurse and midwife practitioners increase globally, this study provides timely evidence from a range of practice settings to guide the design of education programmes and policies governing advanced practice. Study recommendations have broad applicability to all healthcare professionals who are engaged in implementing evidence-based practice into routine care.
Reporting method: Consolidated criteria for reporting qualitative research (COREQ).
Patient or public contribution: No patient or public contribution.
Source: Clarke V. Journal of Advanced Nursing, 2024; 80(4): 1559-1573
Advanced nurse practitioner well‐being: A 4‐year cohort mixed methods study
Abstract:
Aims: To examine changes in advanced nurse practitioner (ANP) well-being, satisfaction and motivation over a four-year period.
Design: Longitudinal Cohort study.
Methods: Surveys were carried out each year from 2019 to 2022 with the same cohort of ANPs in the United Kingdom (UK). The survey consisted of demographics, questions on contemporary issues in advanced practice, National Health Service (NHS) staff survey questions and validated questionnaires. A core set of questions were asked every year with some changes in response to the COVID-19 pandemic.
Results: Response rate ranged from 40% to 59% and appeared to be affected by COVID-19. Staff satisfaction with pay and the well-being score were stable throughout. Other questions on well-being, job satisfaction and motivation saw statistically significant reductions after 4 years. Open-ended questions about ongoing well-being concerns show participants are concerned about exhaustion levels caused by workload, staffing issues, abuse from patients and colleagues' mental health.
Conclusion: The findings highlight a decline in ANP well-being, job satisfaction and motivation post-COVID-19. Reasons for this, explored in the qualitative data, show that ANPs have faced extremely difficult working conditions. Urgent action is required to prevent a workforce retention crisis as many nursing staff are close to retirement and may not be motivated to remain in post.
Impact: This study has followed ANPs through the most challenging years the NHS has ever seen. Job satisfaction, motivation and enjoyment of the job all significantly reduced over time. In many areas, the ANP role has been used to fill medical workforce gaps, and this will become harder to do if ANPs are dissatisfied, disaffected and struggling with stress and burnout. Addressing these issues should be a priority for policymakers and managers.
Patient or public contribution: None as this study focussed on staff. Staff stakeholders involved in the design and conduct of the study.
Source: Wood E. Nursing Open, 2024; 11(7): e2218
Examining advanced clinical practice from the perspective of a trainee advanced clinical practitioner
Abstract: This article discusses advanced clinical practice from the perspective of a trainee advanced clinical practitioner (ACP). The commentary explores the four pillars of advanced practice with respect to the frailty specialty, taking both the author and a trainee ACP into account. The evaluation analyses the historical development of advanced clinical practice and the knowledge, skills and competencies expected at the advanced level. It highlights how support, colleague networking and supervision remain vital to the journey of trainee ACP, and influences the overall wellbeing of, and care given to, the patient.
Source: Carter N. International Journal for Advancing Practice, 2024; 2(2): 1-4
Assessing the benefits of advanced clinical practice for key stakeholders
Abstract:
Design: Longitudinal Cohort study.
Methods: Surveys were carried out each year from 2019 to 2022 with the same cohort of ANPs in the United Kingdom (UK). The survey consisted of demographics, questions on contemporary issues in advanced practice, National Health Service (NHS) staff survey questions and validated questionnaires. A core set of questions were asked every year with some changes in response to the COVID-19 pandemic.
Results: Response rate ranged from 40% to 59% and appeared to be affected by COVID-19. Staff satisfaction with pay and the well-being score were stable throughout. Other questions on well-being, job satisfaction and motivation saw statistically significant reductions after 4 years. Open-ended questions about ongoing well-being concerns show participants are concerned about exhaustion levels caused by workload, staffing issues, abuse from patients and colleagues' mental health.
Conclusion: The findings highlight a decline in ANP well-being, job satisfaction and motivation post-COVID-19. Reasons for this, explored in the qualitative data, show that ANPs have faced extremely difficult working conditions. Urgent action is required to prevent a workforce retention crisis as many nursing staff are close to retirement and may not be motivated to remain in post.
Impact: This study has followed ANPs through the most challenging years the NHS has ever seen. Job satisfaction, motivation and enjoyment of the job all significantly reduced over time. In many areas, the ANP role has been used to fill medical workforce gaps, and this will become harder to do if ANPs are dissatisfied, disaffected and struggling with stress and burnout. Addressing these issues should be a priority for policymakers and managers.
Patient or public contribution: None as this study focussed on staff. Staff stakeholders involved in the design and conduct of the study.
Source: Wood E. Nursing Open, 2024; 11(7): e2218
Examining advanced clinical practice from the perspective of a trainee advanced clinical practitioner
Abstract: This article discusses advanced clinical practice from the perspective of a trainee advanced clinical practitioner (ACP). The commentary explores the four pillars of advanced practice with respect to the frailty specialty, taking both the author and a trainee ACP into account. The evaluation analyses the historical development of advanced clinical practice and the knowledge, skills and competencies expected at the advanced level. It highlights how support, colleague networking and supervision remain vital to the journey of trainee ACP, and influences the overall wellbeing of, and care given to, the patient.
Source: Carter N. International Journal for Advancing Practice, 2024; 2(2): 1-4
Assessing the benefits of advanced clinical practice for key stakeholders
Abstract:
Background: Advanced clinical practice roles, usually filled by nurses, have had positive effects on clinical effectiveness, including in patient satisfaction, but their benefits for other stakeholders (such as employers, health professionals, education providers and commissioners and professional/regulatory bodies) are less clear.
Aim: This study aimed to identify UK research on the potential benefits of advanced clinical practice and evaluate the evidence base for key stakeholders in this field.
Method: A mixed-methods systematic literature review was carried out to inform a narrative interpretive synthesis.
Findings: 44 articles of mixed quality were identified. Consensus was found regarding the definition of and barriers and facilitators to advanced clinical practice. This role is split into substitution (eg, of doctors) and supplementation (eg, adding value) aspects, and the clinical practice element dominates. Training for the role varies, as do scope of practice and regulation.
Conclusion: There are several barriers to the implementation of advanced clinical practice and therefore the realisation of its benefits for key stakeholders. Areas requiring attention include training, support from others for role expansion and organisational issues.
Source: Scott V. British Journal of Nursing, 2024; 33(6): 300-305
The evolving role of advanced clinical practitioners: challenges and opportunities
Abstract: This editorial reviews the roles of advanced clinical practitioners, suggesting how the debate could evolve, returning to the original intent behind these roles and progressing towards ways of sustaining high-quality, equitable and safe care under strong medical leadership.
Source: Britton Carolina R. British Journal of Hospital Medicine, 2024; 85(2): 1-3
A systemised literature review into the benefits of introducing the advanced clinical practitioner role to palliative care patients
Abstract:
Aim: This study aimed to identify UK research on the potential benefits of advanced clinical practice and evaluate the evidence base for key stakeholders in this field.
Method: A mixed-methods systematic literature review was carried out to inform a narrative interpretive synthesis.
Findings: 44 articles of mixed quality were identified. Consensus was found regarding the definition of and barriers and facilitators to advanced clinical practice. This role is split into substitution (eg, of doctors) and supplementation (eg, adding value) aspects, and the clinical practice element dominates. Training for the role varies, as do scope of practice and regulation.
Conclusion: There are several barriers to the implementation of advanced clinical practice and therefore the realisation of its benefits for key stakeholders. Areas requiring attention include training, support from others for role expansion and organisational issues.
Source: Scott V. British Journal of Nursing, 2024; 33(6): 300-305
The evolving role of advanced clinical practitioners: challenges and opportunities
Abstract: This editorial reviews the roles of advanced clinical practitioners, suggesting how the debate could evolve, returning to the original intent behind these roles and progressing towards ways of sustaining high-quality, equitable and safe care under strong medical leadership.
Source: Britton Carolina R. British Journal of Hospital Medicine, 2024; 85(2): 1-3
A systemised literature review into the benefits of introducing the advanced clinical practitioner role to palliative care patients
Abstract:
Background: By 2040, it is predicted that at least 42% more people will need palliative care services in England and Wales. It is not known if introducing advanced clinical practitioners (ACPs) to palliative care environments is beneficial to patients and healthcare organisations.
Aims: This research aims to evaluate if there is a benefit to incorporating ACPs within palliative care environments through data collection on their effectiveness when working in palliative care.
Methods: A systemised review of the literature with a narrative synthesis.
Findings: The literature shows that the ACP role has positive benefits on palliative care in three domains: (1) for the patient, through improving quality of life; (2) for professionals, through education; and (3) for organisations, through cost-effective models of care.
Conclusions: Incorporating the role of the ACP could enable organisations and trusts to deliver new models of care that are both patient-focused and cost-effective. Further research is needed within palliative care on the impact of nurses educated to an MSc level in advanced clinical practice, compared to the traditional role of the clinical nurse specialist.
Source: Graham A. International Journal of Advancing Practice, 2024; 2(3): 144-148
What are advanced clinical practitioners' expectations of the benefits of pursuing the role, and are these being realised?
Abstract:
Aims: This research aims to evaluate if there is a benefit to incorporating ACPs within palliative care environments through data collection on their effectiveness when working in palliative care.
Methods: A systemised review of the literature with a narrative synthesis.
Findings: The literature shows that the ACP role has positive benefits on palliative care in three domains: (1) for the patient, through improving quality of life; (2) for professionals, through education; and (3) for organisations, through cost-effective models of care.
Conclusions: Incorporating the role of the ACP could enable organisations and trusts to deliver new models of care that are both patient-focused and cost-effective. Further research is needed within palliative care on the impact of nurses educated to an MSc level in advanced clinical practice, compared to the traditional role of the clinical nurse specialist.
Source: Graham A. International Journal of Advancing Practice, 2024; 2(3): 144-148
What are advanced clinical practitioners' expectations of the benefits of pursuing the role, and are these being realised?
Abstract:
Background: Advanced clinical practitioners (ACPs) have been used worldwide to reform health services to address population needs. However, previous research identifies barriers that prevent the effective implementation of ACPs.
Aims: To better understand the expectations ACPs have in relation to their roles, and to evaluate whether they are being met so that focused educational and policy initiatives can be developed to reduce gaps between expectation and reality.
Methods: This online cross-sectional study uses a sequential, mixed-methods, exploratory design, in which themes identified from focus groups were used to construct a follow-up questionnaire. Some 291 UK participants were recruited via social media and ACP educational and policy networks. Exploratory data and reflexive thematic analysis were employed to probe and visualise results, drawing findings together into narrative synthesis.
Findings: This research provides insight from a diverse group of ACPs of their lived experiences, aspirations and driving forces to either enter or remain working in the profession. Five themes were identified during focus group discussions: 1) clinical/non-clinical balance; 2) full use of knowledge, skills and experience; 3) leadership in quality improvement; 4) career progression; and 5) policy, vision and organisation. Gaps between ACPs' expectations and their lived experience of the role were identified.
Conclusion: To achieve the expected growth of the ACP role, attention is needed to narrow the gaps between expectations and reality. This includes ringfencing non-clinical activity; enhancing opportunities for professional development, supervision and leadership; providing greater clarity in career planning; and embedding and evaluating efforts to standardise advanced clinical practice.
Source: Scott V. International Journal of Advancing Practice, 2024; 2(4): 164-171
Supporting advanced practice: feedback from a mental health, community and primary care advanced practice support project in South Yorkshire, UK
Abstract:
Aims: To better understand the expectations ACPs have in relation to their roles, and to evaluate whether they are being met so that focused educational and policy initiatives can be developed to reduce gaps between expectation and reality.
Methods: This online cross-sectional study uses a sequential, mixed-methods, exploratory design, in which themes identified from focus groups were used to construct a follow-up questionnaire. Some 291 UK participants were recruited via social media and ACP educational and policy networks. Exploratory data and reflexive thematic analysis were employed to probe and visualise results, drawing findings together into narrative synthesis.
Findings: This research provides insight from a diverse group of ACPs of their lived experiences, aspirations and driving forces to either enter or remain working in the profession. Five themes were identified during focus group discussions: 1) clinical/non-clinical balance; 2) full use of knowledge, skills and experience; 3) leadership in quality improvement; 4) career progression; and 5) policy, vision and organisation. Gaps between ACPs' expectations and their lived experience of the role were identified.
Conclusion: To achieve the expected growth of the ACP role, attention is needed to narrow the gaps between expectations and reality. This includes ringfencing non-clinical activity; enhancing opportunities for professional development, supervision and leadership; providing greater clarity in career planning; and embedding and evaluating efforts to standardise advanced clinical practice.
Source: Scott V. International Journal of Advancing Practice, 2024; 2(4): 164-171
Supporting advanced practice: feedback from a mental health, community and primary care advanced practice support project in South Yorkshire, UK
Abstract:
Background: Despite the significant input from Heath Education England (HEE), now NHS England (NHSE), there are still significant variations around advanced practice programmes, support and training, particularly in less developed areas such as mental health, community posts and primary care. To help target these areas, and to support the NHS Long Term Plan (2023) to increase the number of advanced clinical practitioners (ACPs), the Faculty of Advanced Practice South Yorkshire recruited three ACP leads from mental health, community, and primary care backgrounds to establish a support project led by one professional lead. These leads were able to utilise their lived experience of completing the ACP MSc programme and working as an ACP to help trainee advanced clinical practitioners (tACPs) navigate their journey. The ACP leads also developed a variety of educational events, which further supported the trainees' needs.
Aim: This article reports the feedback given via an online questionnaire from trainees that accessed the project, which ended in March 2024. Its aim is to highlight the often-undervalued concept of using clinicians personal experience regarding advanced training and practice, to mentor, support and ultimately retain the future ACP workforce.
Methods: An email with a link to a questionnaire was sent to 128 tACPs or recently qualified ACPs that had applied for their training via the Faculty of Advanced Practice South Yorkshire. The questionnaire, created in Microsoft Forms, was completed anonymously, and produced both numerical and free-text data. The questionnaire solicited feedback around: the number of contacts they had and how they contacted; the ACP leads; types of support accessed; and the educational events available. Free text answers were analysed by the author (CJ) and a second reviewer (SF) to generate a consensus on themes.
Results: A total of 64 clinicians responded, of which 43 were tACPs, 10 were ACPs, five had other job titles (community matron, pharmacist, practice nurse) and five did not state what their job title was. Responses suggest that the support accessed from the project was highly beneficial and could not be gained elsewhere. A key factor in the project's success was the ACP leads' lived experience of having previously completed advanced practice training, as well as their ability to tailor learning events to the trainees' needs.
Conclusion: Meeting the demands of ACP training in areas where the role is less established remains an ongoing challenge. It seems some of these challenges relate to the lack of practical support being provided by employers or higher education institutions, such as lived experience of completing the task of ACP training. Support projects, like the one discussed in this article, appear aptly placed to help fulfil these needs and begs the question ‘why aren't there more?’, especially when advanced practitioners are fundamental to the future healthcare workforce.
Source: Jenkinson C. International Journal of Advancing Practice, 2024; 2(3): 139-143
The advanced practice nurse role's development and identity: an international review
Abstract: Healthcare is changing; the physician shortage continues to grow and the complexity of health care continues to increase in relation to aging populations, lower reimbursement rates, and increased documentation requirements; an alternative has to be addressed. Globally, the advanced practice nurse (APN) role has grown enormously. Despite the growing use of APN practitioners worldwide, many facilitators and barriers exist to role implementation. Many countries face similar issues, including a lack of clarity and regulation regarding the APN role. Despite these barriers, APNs continue to make headway. This narrative will review barriers and challenges to role advancement across countries and offer opportunities to facilitate APN role development.
Source: Mackavey C. International Journal for Advancing Practice, 2024; 2(1): 36-44
Advanced nursing practice: key factors that have shaped its development in the Republic of Ireland
Abstract: This article explores the development of advanced practice in the Republic of Ireland, highlighting its progressive journey and the key factors that have shaped it. From the initial proposal of advanced roles in nursing and midwifery in 1998 to the establishment of clinical specialist and advanced practice positions, the evolution of advanced practice has been influenced by significant reports, legislative changes, the development of a national educational framework at a MSc advanced nurse practitioner (ANP) level and close collaboration between stakeholders. The article also discusses the distinctions between ANPs and clinical nurse specialists, highlighting the inclusion of medicinal products and ionising radiation prescriptions within the scope of ANPs. Throughout the paper, the regulatory framework and educational standards governing advanced practice in Ireland are highlighted, along with the collaborative efforts of key stakeholders
Source: Lehwaldt D. International Journal for Advancing Practice, 2024; 2(2): 100-102
Advanced practice in Wales
Abstract: In this spotlight article, three members of the UK's advanced practice (AP) landscape, Anna Jones, Ffion Simcox and Jonathan Thomas, detail the development history of AP throughout Wales. They discuss how the Welsh governance and collaborative style differs from that of the rest of the UK, and explore how Wales is developing, leading and innovating across the UK's wider advanced practice landscape
Source: Jones A. International Journal of Advancing Practice, 2024; 2(1): 49-50
Developing standardised pathways for recognition of advanced practice attainment
Abstract: In the UK, advanced practice has a rich developmental history. Since the mid-1980s, there has been a constant evolution in advanced practice innovation; such developments have inadvertently produced unwarranted variations in approaches to implementation of advanced practice roles. Such variations have their origins in multiple intersecting factors such as: multi-professional dimensions with multiple regulators and professional bodies; differences across the four nations of the UK; advanced practice roles growing organically in response to local need, health service commissioning decisions and profession specific imperatives; definitions and understandings of advanced practice differing between professions; and a proliferation of advanced practitioner roles with different titles, different scopes of practice and different educational requirements. All these evident dissimilarities in advanced practice innovations have led to a lack of consistency in implementing advanced practitioner roles, which has caused potential concern for patient safety and impeded effective workforce planning.
Source: Barratt J. International Journal for Advancing Practice, 2024; 2(2): 58-59
Defining the scope of advanced practice
Abstract: Sam Foster, Executive Director of Professional Practice, Nursing and Midwifery Council, considers the issue of defining and regulating the scope of advanced nursing practice.
Source: Foster S. British Journal of Nursing, 2024; 32(20): 1017
Aim: This article reports the feedback given via an online questionnaire from trainees that accessed the project, which ended in March 2024. Its aim is to highlight the often-undervalued concept of using clinicians personal experience regarding advanced training and practice, to mentor, support and ultimately retain the future ACP workforce.
Methods: An email with a link to a questionnaire was sent to 128 tACPs or recently qualified ACPs that had applied for their training via the Faculty of Advanced Practice South Yorkshire. The questionnaire, created in Microsoft Forms, was completed anonymously, and produced both numerical and free-text data. The questionnaire solicited feedback around: the number of contacts they had and how they contacted; the ACP leads; types of support accessed; and the educational events available. Free text answers were analysed by the author (CJ) and a second reviewer (SF) to generate a consensus on themes.
Results: A total of 64 clinicians responded, of which 43 were tACPs, 10 were ACPs, five had other job titles (community matron, pharmacist, practice nurse) and five did not state what their job title was. Responses suggest that the support accessed from the project was highly beneficial and could not be gained elsewhere. A key factor in the project's success was the ACP leads' lived experience of having previously completed advanced practice training, as well as their ability to tailor learning events to the trainees' needs.
Conclusion: Meeting the demands of ACP training in areas where the role is less established remains an ongoing challenge. It seems some of these challenges relate to the lack of practical support being provided by employers or higher education institutions, such as lived experience of completing the task of ACP training. Support projects, like the one discussed in this article, appear aptly placed to help fulfil these needs and begs the question ‘why aren't there more?’, especially when advanced practitioners are fundamental to the future healthcare workforce.
Source: Jenkinson C. International Journal of Advancing Practice, 2024; 2(3): 139-143
The advanced practice nurse role's development and identity: an international review
Abstract: Healthcare is changing; the physician shortage continues to grow and the complexity of health care continues to increase in relation to aging populations, lower reimbursement rates, and increased documentation requirements; an alternative has to be addressed. Globally, the advanced practice nurse (APN) role has grown enormously. Despite the growing use of APN practitioners worldwide, many facilitators and barriers exist to role implementation. Many countries face similar issues, including a lack of clarity and regulation regarding the APN role. Despite these barriers, APNs continue to make headway. This narrative will review barriers and challenges to role advancement across countries and offer opportunities to facilitate APN role development.
Source: Mackavey C. International Journal for Advancing Practice, 2024; 2(1): 36-44
Advanced nursing practice: key factors that have shaped its development in the Republic of Ireland
Abstract: This article explores the development of advanced practice in the Republic of Ireland, highlighting its progressive journey and the key factors that have shaped it. From the initial proposal of advanced roles in nursing and midwifery in 1998 to the establishment of clinical specialist and advanced practice positions, the evolution of advanced practice has been influenced by significant reports, legislative changes, the development of a national educational framework at a MSc advanced nurse practitioner (ANP) level and close collaboration between stakeholders. The article also discusses the distinctions between ANPs and clinical nurse specialists, highlighting the inclusion of medicinal products and ionising radiation prescriptions within the scope of ANPs. Throughout the paper, the regulatory framework and educational standards governing advanced practice in Ireland are highlighted, along with the collaborative efforts of key stakeholders
Source: Lehwaldt D. International Journal for Advancing Practice, 2024; 2(2): 100-102
Advanced practice in Wales
Abstract: In this spotlight article, three members of the UK's advanced practice (AP) landscape, Anna Jones, Ffion Simcox and Jonathan Thomas, detail the development history of AP throughout Wales. They discuss how the Welsh governance and collaborative style differs from that of the rest of the UK, and explore how Wales is developing, leading and innovating across the UK's wider advanced practice landscape
Source: Jones A. International Journal of Advancing Practice, 2024; 2(1): 49-50
Developing standardised pathways for recognition of advanced practice attainment
Abstract: In the UK, advanced practice has a rich developmental history. Since the mid-1980s, there has been a constant evolution in advanced practice innovation; such developments have inadvertently produced unwarranted variations in approaches to implementation of advanced practice roles. Such variations have their origins in multiple intersecting factors such as: multi-professional dimensions with multiple regulators and professional bodies; differences across the four nations of the UK; advanced practice roles growing organically in response to local need, health service commissioning decisions and profession specific imperatives; definitions and understandings of advanced practice differing between professions; and a proliferation of advanced practitioner roles with different titles, different scopes of practice and different educational requirements. All these evident dissimilarities in advanced practice innovations have led to a lack of consistency in implementing advanced practitioner roles, which has caused potential concern for patient safety and impeded effective workforce planning.
Source: Barratt J. International Journal for Advancing Practice, 2024; 2(2): 58-59
Defining the scope of advanced practice
Abstract: Sam Foster, Executive Director of Professional Practice, Nursing and Midwifery Council, considers the issue of defining and regulating the scope of advanced nursing practice.
Source: Foster S. British Journal of Nursing, 2024; 32(20): 1017
Friday, October 18, 2024
Sepsis Champions: October 2024
Welcome to the latest key papers and publications focussing mainly on all things sepsis in the nursing profession.
Please click on the links below and enter your OpenAthens username and password to download the full text or contact the library at esth.hirsonlibrary@nhs.net to request the full text.
Multimodal Quality Initiatives in Sepsis Care: Assessing Impact on Core Measures and Outcomes
Abstract: Providing timely and effective care for patients with sepsis is challenging due to delays in recognition and intervention. The Surviving Sepsis Campaign has developed bundles that have been shown to reduce sepsis mortality. However, hospitals have not consistently adhered to these bundles, resulting in suboptimal outcomes. To address this, a multimodal quality improvement sepsis program was implemented from 2017 to 2022 in a large urban tertiary hospital. The aim of this program was to enhance the Severe Sepsis and Septic Shock Management Bundle compliance and reduce sepsis mortality. At baseline, the Severe Sepsis and Septic Shock Management Bundle compliance rates were low, at 25%, with a sepsis observed/expected mortality ratio of 1.14. Our interventions included the formation of a multidisciplinary committee, the appointment of sepsis champions, the implementation of sepsis alerts and order sets, the formation of a Code Sepsis team, real-time audits, and peer-to-peer education. By 2022, compliance rose to 62%, and the observed/expected mortality ratio decreased to 0.73. Our approach led to improved outcomes and hospital rankings. These findings underscore the efficacy of a comprehensive sepsis care initiative, emphasizing the importance of interdisciplinary collaboration. A multimodal hospital-wide sepsis performance program is feasible and can contribute to improved outcomes. However, further research is necessary to determine the specific impact of individual strategies on sepsis outcomes.
Source: Garcia M. Journal for Healthcare Quality, 2024 Jul-Aug; 46(4): 245-250
Contact the library for a copy of this article
Sepsis without borders
Abstract: Sepsis is a global public health problem, accounting for 48.9 million cases and 11 million sepsis-related deaths worldwide in 2020, with the highest burden felt in low-income countries (LICs) (World Health Organization (WHO), 2024a). The main challenge is that as a syndrome and not a disease, the range of signs and symptoms seen can make it difficult to diagnose in its early stages. In consequence, health professionals always need to rule out sepsis rather than rule it in, using the question ‘Could it be sepsis?’ (Sepsis Trust, 2024). This comment piece highlights the ongoing nature of the burden of sepsis, as countries continue to grapple with this global problem.
Source: Carter C. British Journal of Nursing, 2024 Jul; 33(14): 654-655
The frequency of sepsis-associated delirium in intensive care unit and its effect on nurse workload
Abstract: Aim: To determine the frequency of sepsis-associated delirium (SAD) in the intensive care unit and its effect on nurse workload.
Design: A cross-sectional and correlational design was used.
Methods: The study was conducted with 158 patients in the adult intensive care unit of a hospital between October 28 and July 28, 2022. Data analysis included frequency, chi-squared/fisher's exact test, independent samples t-test, correlation analysis, simple and multiple linear regression analyses. The study adhered to the STROBE guidelines.
Results: Sepsis was detected in 12.7% of the patients, delirium in 39.9%, and SAD in 10.1%. SAD was more common in males (19%) and 56.3% of the patients were admitted to the unit from the emergency department. Patients developing SAD had significantly higher age and mean sequential organ failure evaluation, acute physiology and chronic health evaluation II, and C-reactive protein and lactate scores, but their Glasgow Coma Scale scores were significantly low. There was a moderate positive relationship between the patients' Sequential Organ Failure Assessment score and the presence of SAD. The most common source of infection in patients diagnosed with SAD was bloodstream infection (44.4%). SAD significantly increased nurse workload and average care time (1.8 h) and it explained 22.8% of the total variance in nurse workload. Additionally, the use of antibiotics, vasopressors and invasive mechanical ventilation significantly increased nurse workload.
Conclusion: In the study, in patients who developed SAD increased nurse workload and average care time significantly. Preventive nursing approaches and effective management of SAD can reduce the rate of development of SAD and nurse workload.
Implications for the profession and patient care: It is important to work with routine screening, prevention and patient–nurse ratio appropriate to the workload for SAD.
Source: Alici S. Journal of Clinical Nursing, 2024 May; Online ahead of print
Emergency clinicians' use of adult and paediatric sepsis pathways: An implementation redesign using the behaviour change wheel
Abstract: Aims: To identify facilitators and barriers and tailor implementation strategies to optimize emergency clinician's use of adult and paediatric sepsis pathways.
Design: A qualitative descriptive study using focus group methodology.
Methods: Twenty-two emergency nurses and ten emergency medical officers from four Australian EDs participated in eight virtual focus groups. Participants were asked about their experiences using the New South Wales Clinical Excellence Commission adult and paediatric sepsis pathways using a semi-structured interview template. Facilitators and barriers to use of the sepsis pathways were categorized using the Theoretical Domains Framework. Tailored interventions were selected to address facilitators and barriers, and a re-implementation plan was devised guided by the Behaviour Change Wheel.
Results: Thirty-two facilitators and 58 barriers were identified corresponding to 11 Theoretical Domains Framework domains. Tailored strategies were selected to optimize emergency clinicians' use of the sepsis pathways including refinement of existing education and training programmes, modifications to the electronic medical record system, introduction of an audit and feedback system, staffing strategies and additional resources.
Conclusion: The implementation of sepsis pathways in the Emergency Department setting is complex, impacted by a multitude of factors requiring tailored strategies to address facilitators and barriers and optimize uptake.
Implications for Patient Care: This study presents a theory-informed systematic approach to successfully implement and embed adult and paediatric sepsis pathways into clinical practice in the Emergency Department.
Impact: Optimizing uptake of sepsis pathways has the potential to improve sepsis recognition and management, subsequently improving the outcome of patients with sepsis.
Reporting Method: The Consolidated Criteria for REporting Qualitative research guided the preparation of this report.
Patient or Public Contribution: Nil.
Source: Munroe B. Journal of Advanced Nursing, 2024 September; Online ahead of print
Predicting sepsis at emergency department triage: Implementing clinical and laboratory markers within the first nursing assessment to enhance diagnostic accuracy
Abstract: Background: Early identification of sepsis in the emergency department (ED) triage is both valuable and challenging. Numerous studies have endeavored to pinpoint clinical and biochemical criteria to assist clinicians in the prompt diagnosis of sepsis, but few studies have assessed the efficacy of these criteria in the ED triage setting. The aim of the study was to explore the accuracy of clinical and laboratory markers evaluated at the triage level in identifying patients with sepsis.
Methods: A prospective study was conducted in a large academic urban hospital, implementing a triage protocol aimed at early identification of septic patients based on clinical and laboratory markers. A multidisciplinary panel of experts reviewed cases to ensure accurate identification of septic patients. Variables analyzed included: Charlson comorbidity index, mean arterial pressure (MAP), partial pressure of carbon dioxide (PetCO2), white cell count, eosinophil count, C-reactive protein to albumin ratio, procalcitonin, and lactate.
Results: A total of 235 patients were included. Multivariable analysis identified procalcitonin ≥1 ng/mL (OR 5.2; p < 0.001); CRP-to-albumin ratio ≥32 (OR 6.6; p < 0.001); PetCO2 ≤ 28 mmHg (OR 2.7; p = 0.031), and MAP <85 mmHg (OR 7.5; p < 0.001) as independent predictors for sepsis. MAP ≥85 mmHg, CRP/albumin ratio <32, and procalcitonin <1 ng/mL demonstrated negative predictive values for sepsis of 90%, 89%, and 88%, respectively.
Conclusions: Our study underscores the significance of procalcitonin and mean arterial pressure, while introducing CRP/albumin ratio and PetCO2 as important variables to consider in the very initial assessment of patients with suspected sepsis in the ED.
Clinical relevance: Early identification of sepsis since the emergency department (ED) triage is challenging Implementing the ED triage protocol with simple clinical and laboratory markers allows to recognize patients with sepsis with a very good discriminatory power (AUC 0.88).
Source: Sisto U G. Journal of Nursing Scholarship, 2024 June; Online ahead of print
Association between measures of resuscitation in the critical care resuscitation unit and in-hospital mortality among patients with sepsis
Abstract: Objectives: We hypothesized that lactate clearance and reduction of the Sequential Organ Failure Assessment (SOFA) score during patients’ critical care resuscitation unit (CCRU) stay would be associated with lower in-hospital mortality.
Methods: This was a retrospective study of adult patients who had sepsis diagnoses and were admitted to the CCRU in 2018. Multivariable logistic regression analysis was performed to assess the association of clinical factors, lactate clearance, and SOFA reduction with hospital mortality.
Results: A total of 401 patients with lactate clearance data and 455 patients with SOFA score data were included in the study. The mean (SD) lactate and SOFA score on admission were 2.2 (1.8) mmol/L and 4.4 (4.3), respectively. Average lactate clearance was 0.1 (2.6) mmol/L, and average SOFA score reduction was 0.65 (5.9). Patients with a one point reduction in SOFA score during their CCRU stay had a 31% reduction of mortality (odds ratio [OR] 0.69, 95% confidence interval [CI] 0.62–0.77, p < 0.001). SOFA score reduction was associated with lower hospital mortality for both surgical patients (OR 0.69, 95% CI 0.58–0.81, p < 0.001) and non-surgical patients (OR 0.71 95% CI 0.06–0.83, p < 0.001).
Conclusion: SOFA score reduction, but not lactate clearance during the CCRU stay, was associated with lower odds of in-hospital mortality. These findings suggest that resuscitative efforts leading to an early improvement in SOFA score may benefit patients with sepsis.
Source: Emamian N. Journal of the American College of Emergency Physicians, 2024 August; 5(5): e13281
Outcomes and prognosis of sepsis and septic shock in critically ill hematology patients
Abstract: Introduction and aim: Hematology patients are at high risk for sepsis/septic shock as a result of both their primary disease and treatment. In this patient population, it is very important to examine the entire course of sepsis/septic shock and to define the affecting factors in order to determine the measures for reducing sepsis-related mortality.
Patients and methods: The patients admitted to hematology intensive care unit (ICU) in a university hospital were retrospectively examined between January 01, 2018 and December 31, 2022. Those followed up with the diagnosis of sepsis/septic shock were included in the study. The demographic characteristics of the patients, comorbidities, reasons for ICU admission, organ failure scores on ICU admission, underlying hematological diseases and the status of diseases, the presence of neutropenia, decubitus wounds, nutritional support, the source of the infection and infectious agents, sepsis/septic shock-related complications and laboratory data were evaluated in detail. The effects of these data on mortality were examined.
Results: A total of 260 sepsis episodes of 149 patients were analyzed. The underlying hematological diseases, 32.8% were acute leukemia, 24.2% multiple meyloma, 20.8% lymphoproliferative disease, 12.1% chronic leukemia and HSCT was performed in 65 patients. The median SOFA score at ICU admission was 9 (7–12) and the APACHE-II median was 25 (20–32). The most common sources of infection were pulmonary infection with a rate of 73.8% and blood stream infection (BSI) with a rate of 42.3%. The ICU mortality rate was 50,3%. The SOFA score at ICU admission, admission from inpatient clinics or other ICUs, presence of neutropenia and decubitus wound, laboratory findings such as procalcitonin (PCT), lactate, creatinine and pH, sepsis/septic shock-related complications, source of infections, culture negativity, and presence of fungal infection were all defined as significant factors affecting mortality in univariate analysis. The admission from inpatient clinics or other ICUs, SOFA score and presence of decubitus wound at ICU admission, not feeding orally or enterally, BSI as a sepsis/septic shock source, and requirement for renal replacement therapy (RRT) were defined as independent variables for ICU mortality in logistic regression analysis (Table 1).
Conclusion: This study showed that the course and prognosis of sepsis/septic shock were determined by presence of organ failure (SOFA score) and decubitus wounds (indirect indicator of performance status), not feeding orally and enterally, and requirement of RRT rather than the variables related to the underlying hematological disease.
Source: Bozkurt H K. Journal of Critical Care, 2024 June; 81: 154653
Contact the library for a copy of this article
Effect of an interdisciplinary sepsis team on the management of patients with sepsis and septic shock in the emergency department: A literature review
Abstract: Introduction and aim: Sepsis is a life-threatening condition which is due to a systematic inflammatory and immune response to an infection. The optimization of the management of patients with sepsis, requires immediate identification, appropriate antibiotic therapy, hemodynamic support, and control of the source of infection. Delayed early identification, and initiation of treatment can lead to septic shock, multiorgan failure, and death. Through the literature, it seems that the existence of an interdisciplinary sepsis team is a factor that contributes significantly to the improvement of sepsis recognition, as well as compliance with the guidelines and consequently to the improvement of patients' outcomes. To investigate the literature regarding the impact of an interdisciplinary sepsis team on the degree of compliance with the Surviving Sepsis Campaign (SSC) guidelines (1-Hour Bundle: whether they are implemented and times) in ERs.
Patients and methods: Α systematic review of the literature in the PubMed and CINAHL databases using specific keywords, inclusion and exclusion criteria. The search was established during the period 2022–2023. NOS tool was used for the quality assessment of the research methodology of the studies included in the current review.
Results: The search resulted in a total of 9 studies published during the period 2017–2022. 4 of them were retrospective, 1 cohort, 1 quasi-experimental, 2 retrospective and prospective studies and 1 prospective study. The results show a statistically significant improvement in compliance with sepsis guidelines within 1 h in taking blood cultures before giving antibiotics (40% to 85%), administration of broad-spectrum antibiotics (25% to 76.9%), administration of crystalloid intravenous fluids (30 ml/kg BW), (31% to 81%), administration of vasopressors drugs if hypotension persists after administration of intravenous fluids (43% to 58%), in measurement of 1st lactate (13% to 47%), and 2nd lactic acid (76% to 90%) within 3 h.
Conclusion: Interdisciplinary sepsis management teams can use existing knowledge, skills and tools to improve sepsis compliance by improving the processing time of measures, such as improving the time to measure lactate, administer fluids, take blood cultures and administer antibiotics.
Source: Georgiou C. Journal of Critical Care, 2024 June; 81: 154666
Contact the library for a copy of this article
Effect of antibiotics efficacy in patients with sepsis and septic shock presenting in the emergency department: A literature review
Abstract: Introduction and aim: Sepsis is a life-threatening condition which is due to a systematic inflammatory and immune response to an infection. Patients comes in Emergency Department (ERs) with infections that could lead in sepsis and septic shock. Approximately 50 million patients develop severe sepsis and septic shock worldwide. More than half are admitted to an intensive care unit (ICU). Early diagnosis and treatment of these patients is critical and is associated not only with improved morbidity and mortality, but also with reduced length of hospital stay (LOS). As a consequence of the immediate recognition of sepsis, the timely administration of antibiotics is a necessary condition for its effective treatment. To investigate the literature regarding the effectiveness of timely administration of antibiotics in patients with sepsis in the ERs.
Patients and methods: Α systematic review of the literature in the PubMed and CINAHL databases. All possible combinations have been using the word “andâ€. Study Inclusion criteria were: a) studies examining the timely administration of antibiotics in septic patients, b) studies correlating the time of antibiotic administration and in-hospital mortality, c) published in scientific journals in English, the last 5 years.
Results: The search resulted in a total of 7 studies. 4 from Asia, 2 from USA and 1 from United Kingdom, that were published between 2017 and 2022. It is argued that the untimely administration of antibiotics increases mortality. In-hospital mortality rates were reduced in patients receiving antibiotics within 1 h (30% to 18%), (p < 0,001) compared to those who did not receive the timely treatment (20% to 55%) (p = 0.046), (p = 0.009). Among patients who received antibiotics within the appropriate time showed 35% (p = 0.042), (p < 0,001) increased risk of mortality for every 1 h delay in antibiotics.
Conclusion: Early administration of antibiotics improves outcomes in patients with sepsis and septic shock. Delays in the initiation of antibiotics in the emergency department are associated with a clinically significant increase in the risk of mortality from sepsis. The need to improve the timely treatment of patients with sepsis who come to the ERs is emphasized.
Source: Georgiou C. Journal of Critical Care, 2024 June; 81: 154667
Contact the library for a copy of this article
Recognition, diagnosis, and early management of suspected sepsis: summary of updated NICE guidance
Abstract: What you need to know: Calculate NEWS2 scores to determine an adult’s risk of severe illness or death from sepsis in acute hospital, mental health, and ambulance settings. Use the person’s risk level to help determine the time window in which to give antibiotics.
Sepsis is defined as life threatening organ dysfunction caused by a dysregulated host response to infection.1 In 2016, the National Institute for Health and Care Excellence (NICE) first published guidance on recognising, diagnosing, and managing suspected sepsis. [...]in January 2024, NICE guidance was updated to include NEWS2 for stratifying risk of severe illness or death from sepsis.4 The updated guideline aims to ensure that early recognition of patient deterioration and treatment for sepsis becomes standardised nationally, and includes recommendations on the timing of antibiotic prescribing based on a person’s risk level, while investigating the underlying infection source. Evaluating risk level using NEWS2 A new recommendation was made that NEWS2 scores should be recorded for all patients aged 16 and over (excluding people who are or have recently been pregnant) in acute hospital, mental health, and ambulance settings to help stratify risk of severe illness or death from sepsis. Deferring administration of a broad spectrum antibiotic treatment for up to three hours after calculating the person’s first NEWS2 score on initial assessment in the emergency department or deterioration in the ward, and using this time to gather information for a more specific diagnosis. Discussing the person’s condition with a senior clinical decision maker.
Source: Gildea A. BMJ, 2024 June; 385: q1173
Fluid Resuscitation and Sepsis Management in Patients with Chronic Kidney Disease Or Endstage Renal Disease: Scoping Review
Abstract: Managing sepsis and fluid resuscitation in patients with chronic kidney disease or end-stage renal disease is challenging for health care providers. Nurses are essential for early identification and treatment of these patients. Nurse education on assessing perfusion and implementing 3-hour bundled care can improve mortality rates in patients with sepsis. In this scoping review, initial screening identified 1176 articles published from 2015 through 2023 in the National Library of Medicine database; 29 articles were included in the literature summary and evidence synthesis. A systematic review meta-analysis was not possible because of data heterogeneity. The review revealed that most patients with chronic kidney disease or end-stage renal disease received more conservative resuscitation than did the general population, most likely because of concerns about volume overload. However, patients with chronic kidney disease or end-stage renal disease could tolerate the standard initial fluid resuscitation bolus of 30 mL/kg for sepsis. Outcomes in patients with chronic kidney disease or end-stage renal disease were similar to outcomes in patients without those conditions, whether they received standard or conservative fluid resuscitation. Patients who received the standard (higher) fluid resuscitation volume did not have increased rates of complications such as longer duration of mechanical ventilation, increased mortality, or prolonged length of stay. Using fluid responsiveness to guide resuscitation was associated with improved outcomes. The standard initial fluid resuscitation bolus of 30 mL/kg may be safe for patients with chronic kidney disease or end-stage renal disease and sepsis. Fluid responsiveness could be a valuable resuscitation criterion, promoting better decision-making by multidisciplinary teams. Further research is required.
Source: Haley M. American Journal of Critical Care, 2024 January; 33(1): 45-53
Clinical evaluation of different sepsis filters
Abstract: Introduction and aim: Sepsis is a life-threatening organ dysfunction in response to a host's infection. In addition to treatments with proven efficacy in sepsis, there are also treatment methods under investigation. The use of cytokine filters is recognized as a promising adjunctive therapy in the treatment of sepsis. The aim of this study is to evaluate the results of sepsis cytokine filters applied in sepsis patients.
Patients and methods: In this retrospective single center study, 17 patients who were followed up in the Internal Diseases Intensive Care Clinic of Kayseri City Hospital due to sepsis and were applied sepsis cytokine filter were included in the study. Three sepsis filters were applied to the patients according to their clinical status. CPFA sepsis filter was applied in 5 patients(Group 1), Oxiris in 7 patients(Group 2), and Jafron HA330 in 5 patients(Group 3).ResultsThe mean age of the patients was 67.1 ± 17.9 years. Seven of the patients were femal (41%) and 10 were male(59%). The hospitalization period of the patients was 30.1 ± 32.3 days and the day of hospitalization in the intensive care unit was 11.1 ± 8.8 days. The mean APACHE value of the patients was 32.8 ± 7.1 and the hospitalization glaskow coma score was 10.3 ± 3.3. There was a significant difference between the glaskow coma score at the intensive care unit admission and the glaskow coma score at the time of discharge from the intensive care unit (p = 0.010). CRP decrease rates and procalcitonin decrease rates before and after sepsis filter were significant, but WBC decrease rate was not significant (p < 0.001, p = 0.001, and p = 0.570, respectively). Procalcitonin decrease percentages of the patients were 0.87 ± 0.15, and CRP decrease percentages were 0.64 ± 0.31. The percentages of decrease in Procalcitonin were found to be significant in the CPFA sepsis filter applied group compared to the groups in which Oxiris and Jafron HA330 were applied (p = 0.020), there was no difference between the three groups in terms of CRP decrease percentages (p = 0.755). There was no difference in mortality between the groups.
Conclusion: Sepsis cytokine filters have been shown in many studies to contribute positively to reducing procalcitonin and CRP values. It has been reported that cytokine filters used in selected sepsis patients have positive effects on mortality. The significant decrease in the percentage of procalcitonin in CPFA may be due to the smaller pore size. Studies to be conducted in larger patient groups will be appropriate in terms of evaluating the effect on mortality.
Source: Sirakaya H A. Journal of Critical Care, 2024 June; 81: 154719
Contact the library for a copy of this article
Can Artificial Intelligence and Machine Learning Techniques improve the ability to detect Sepsis and Septic Shock. A retrospective study of 218,562 adult patients in a university hospital
Abstract: Introduction and aim: The use of Artificial Intelligence (AI) and Machine Learning (ML) techniques has improved a sepsis (SE) and septic shock (SS) early detection compared with traditional rules according to recent retrospective, prospective and meta-analysis (1). Develop predictive models using algorithms based on AI-ML techniques and compare with fixed rules for SE/SS detection, assessing whether these new models improve predictive capability.
Methods: We carried out an observational, retrospective non interventional study developed in our University General Hospital. The period assessed was from January 2014 to October 2018. The diagnosis and validation of each SE or SS case were made prospectively by the clinical experts of the Multidisciplinary Sepsis Unit (MSU). We used a Sepsis 2 definition. We developed AI-ML techniques from historical data from the Electronic Health Record (EHR). The structured variables were obtained from different data sources and from non-structured text from the Triage and Emergency Department (ED). The Mann-Whitney-Wilcoxon test was used to identify statistically significant clinical and analytical variables, as well as wrapper techniques, with a significance level of 0.01 and to obtain relevant unstructured data using a Natural Language Processing (NLP) techniques.
Results: A total of 815,170 records of the EHR have been assessed. We included 218.562 adult patients from all hospital departments. We divided into 2 groups: 1) with SE/SS were 9301 (4.6%); and 2) 209,261 (95.4%) who did NOT have sepsis (NSE). A total of 3927 variables have been extracted from the different data sources. By relevance and after being validated by the UMS team, 244 (6.2%) both structured and unstructured variables were associated with the detection of SE/SS. Within the structured variables, we identified many that are not blackened by the classic scorings of SE/SS, such as hemoglobin or eosinopenia. We developed about 30 different predictive models for SE/SS detection, using fixed rules individually, using only AI-ML based algorithms or the combination of fixed rules with AI-ML techniques. The best model using only fixed rules was the one using the Sepsis.2 criterion, while the best model using AI-ML techniques was called BISEPRO and was a combination of SEPSIS.2 with AI-ML techniques.
Conclusion: In this retrospective study including adult patients in all areas of a hospital the use of AI-ML based techniques was significantly superior for the detection of SE/SS.
Source: Gonzalez V L H. Journal of Critical Care, 2024 June; 81: 154684
Contact the library for a copy of this article
Hemodynamic profile of cirrhotic patients with sepsis and septic shock: A propensity score matched case-control study
Abstract: Purpose: Our understanding of hemodynamics in cirrhotic patients with sepsis remains limited. Our study aims to investigate differences in hemodynamic profiles using echocardiography between septic patients with and without cirrhosis.
Materials and methods: This is a single-center, retrospective study of septic patients with echocardiogram within 3 days of ICU admission. We compared baseline characteristics, echocardiographic markers of LV systolic function arterial load between patients with and without cirrhosis. A propensity score-matched case-control model was developed to describe the differences in those echocardiography derived parameters between the groups.
Results: 3151 patients with sepsis were included of which 422 (13%) had cirrhosis. In the propensity score matched group with 828 patients, cirrhotic patients had significantly higher left ventricular ejection fraction (64 vs.56%, p < 0.001) and stroke volume (72 vs.48 ml, p < 0.001) along with lower arterial elastance (Ea) (1.35 1vs.20.3, p < 0.001) and systemic vascular resistance (SVR) (851 vs.1209 dynes/s/m−5, p = 0.001). The left ventricular elastance (Ees) (2.83 vs 2.45, p = 0.002) was higher and ventricular-arterial coupling (Ea/Ees) (0.48 vs. 0.86, p < 0.001) lower in cirrhotic compared to non-cirrhotic.
Conclusions: Septic patients with cirrhosis had higher LVEF with lower Ea and SVR with higher Ees and significantly lower Ea/Ees suggesting vasodilation as the principal driver of the hyperdynamic profile in cirrhosis.
Source: You J Y. Journal of Critical Care, 2024 June; 81: 154532
Contact the library for a copy of this article
Time Is Survival: Continuing Education on Sepsis for Neurosurgical Critical Care Nurses
Abstract: Background: Early identification of sepsis among neurosurgical critical care patients is a significant challenge because of the many possible confounding variables that lead to altered mental status in this specific patient population. Nurses' knowledge, attitudes, confidence, and practices related to the early identification and management of sepsis are crucial to patients' survival.
Method: This evidence-based intervention project implemented continuing education for neurosurgical critical care nurses on the early signs and symptoms of sepsis and the management of sepsis according to the Surviving Sepsis Campaign (SSC) Guidelines.
Results: Continuing education on sepsis increased neurosurgical critical care nurses' knowledge of the SSC 1-hour sepsis bundle, reported confidence in the management of sepsis, and likelihood of assessing for sepsis.
Conclusion: Continuing education for neurosurgical critical care nurses on the signs and symptoms of sepsis and the SSC Guidelines is necessary and may improve patient outcomes.
Source: Rios E M. Journal of Continuing Education in Nursing, 2024 May; 55(5): 224–230
Previously healthy adults among septic patients: Population-level epidemiology and outcomes
Abstract: Purpose: Previously healthy adults with community-onset sepsis were recently reported to have, counterintuitively, higher short-term mortality than those with comorbid conditions. However, the population-level generalizability of this finding and its applicability to all hospitalized septic patients are unclear.
Methods: We used a statewide dataset to identify hospitalizations aged ≥18 years with a diagnosis of sepsis in Texas during 2018–2019. Comorbidities were defined as those included in the Charlson Comorbidity Index and other prevalent conditions associated with mortality. Hierarchical models were used to estimate the association of comorbid state with short-term mortality (defined as in-hospital mortality or discharge to hospice), overall and in community-onset and hospital-onset sepsis.
Results: Among 120,371 sepsis hospitalizations, 6611 (5.5%) were previously healthy and 105,455 (87.6%) had community-onset sepsis. Short-term mortality among the previously healthy and those with comorbidities was 11.7% vs 28.2% overall, 11.0% vs 25.2% in community-onset sepsis, and 22.0% vs 48.7% in hospital-onset sepsis, respectively. On adjusted analysis, being previously healthy remained associated with lower short-term mortality overall (adjusted odds ratio 0.62 [95% CI 0.57–0.69]), with findings consistent with the primary analysis in community-onset sepsis, hospital-onset sepsis.
Conclusions: Previously healthy septic patients had lower short-term mortality compared to those with comorbid conditions.
Source: Oud L. Journal of Critical Care, 2024 February; 79: 154427
Contact the library for a copy of this article
Early prediction of sepsis in intensive care patients using the machine learning algorithm NAVOY® Sepsis, a prospective randomized clinical validation study
Abstract: Purpose: To prospectively validate, in an ICU setting, the prognostic accuracy of the sepsis prediction algorithm NAVOY® Sepsis which uses 4 h of input for routinely collected vital parameters, blood gas values, and lab values.
Materials and methods: Patients 18 years or older admitted to the ICU at Skåne University Hospital Malmö from December 2020 to September 2021 were recruited in the study. A total of 304 patients were randomized into one of two groups: Algorithm group with active sepsis alerts, or Standard of care. NAVOY® Sepsis made silent predictions in the Standard of care group, in order to evaluate its performance without disturbing the outcome. The study was blinded, i.e., study personnel did not know to which group patients were randomized. The healthcare provider followed standard practices in assessing possible development of sepsis and intervening accordingly. The patients were followed-up in the study until ICU discharge.
Results: NAVOY® Sepsis could predict the development of sepsis, according to the Sepsis-3 criteria, three hours before sepsis onset with high performance: accuracy 0.79; sensitivity 0.80; and specificity 0.78.
Conclusions: The accuracy, sensitivity, and specificity were all high, validating the prognostic accuracy of NAVOY® Sepsis in an ICU setting, including Covid-19 patients.
Source: Persson I. Journal of Critical Care, 2024 April; 80: 154400
Embracing a New Evidence-Based Thought Paradigm of Sepsis
Abstract: In 1991, sepsis was first defined by the Society of Critical Care Medicine as the systemic inflammatory response syndrome, in the presence of infection. Systemic inflammatory response syndrome is an adaptive host response to infection, as well as to other insults like trauma and stress. Research pertaining to sepsis was guided by this adaptive definition for 25 years. After established guidelines for sepsis management were challenged in 2014, sepsis was redefined in 2016 as a dysregulated host response to infection. However, there still remains no consensus on which immunologic or metabolic mechanisms have become dysregulated. We sought to examine sepsis literature published after the 2016 consensus definition and compare it to the original systemic inflammatory response syndrome paradigm proposed in 1991. The purpose of this intensive analysis was to recommend a new sepsis archetype, with consideration to dysregulated immunologic and metabolic mechanisms that have recently been identified in sepsis. Nurses and other clinicians must shift their thought paradigm toward an evidence-based dysregulated model, in order to improve on sepsis recognition and management.
Source: Richardson L. Clinical Nurse Specialist, 2024 Jul – Aug; 38(4): 171–174
Burden of sepsis in critically ill children with cancer: A retrospective study
Abstract: Introduction and aim: The mortality of pediatric intensive care unit is 27.8% globally and its even higher, i.e. 46.2% in children with sepsis. Children with cancer suffer higher incidence as well as severity of sepsis. Five-year survival of children with cancer has tremendously improved to 83% and two thirds of them require at least one intensive care admission throughout their disease course. Sepsis is the commonest cause of admission and death in intensive care (ICU).We aim to review mortality in critically ill children with cancer with respect to sepsis and its causative microorganisms.
Patients and methods: We retrospectively studied all pediatric admissions to ICU during the period from 1st January 2022 to 31st December 2022 in a tertiary cancer hospital in Mumbai, India. The primary outcome was ICU mortality in this cohort and secondary outcomes included proportion of children admitted with sepsis, suspected source of sepsis, culture results with special focus on ESKAPE organisms (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumanii, Pseudomonas aeruginosa, Enterobacter species).
Results: Over a period of 12 months, 386 children (0–18 years) had 513 admissions in our ICU, with 138 girls (35.8%) and 248 males (64.2%). The ICU mortality was 22.5%. Two hundred and twenty four (58%) patients were admitted with sepsis, out of which 82 patients had culture positive results in one or more samples such as blood, bronchoalveolar lavage, cerebrospinal fluid, etc. The ESKAPE organisms constituted most of the culture isolates with Escherichia coli being the most common, followed by Klebsiella and Pseudomonas. Nearly half of the children (42/82) with positive culture results died as opposed to one fourth mortality in children with culture negative results (32/141). The gram-negative bacilli exhibited a high incidence of carbapenem resistance. Overall incidence of gram-positive infections was low. Viral and fungal infections were diagnosed more clinically or radiologically, or using molecular testing, serum biomarkers as opposed to culture testing.
Conclusions: Sepsis with ESKAPE organism is a major concern in critically ill children with cancer. The high mortality and rising antimicrobial resistance demand focus on tailoring research to improve outcomes in this patient population.
Source: Sharma S. Journal of Critical Care, June 2024; 81: 154599
Contact the library for a copy of this article
Analysis of the factors that contributed to the passage of Rory's regulations using the 3I + E framework: Implications for future sepsis policy
Abstract: Introduction and aim: Sepsis is the dysregulated host response to an infection, accounting for an estimated 48.9 million cases and 11 million sepsis-related deaths worldwide. In 2013, New York State passed Rory's Regulations, requiring all hospitals to develop protocols for early identification and treatment of sepsis. The purpose of this analysis is to (a) identify and describe the ideas, interests, and institutions that led to the New York State Sepsis Regulations; and (b) the implications for future sepsis policy.
Methods: This study was a retrospective document analysis using qualitative description. To guide this policy analysis, the framework was utilized. This framework includes consideration of institutions, interests, ideas, and external factors and is the most appropriate methodology to identify the factors that contribute to the development of a policy. To identify relevant sources of information, we conducted (a) a literature search of academic databases; (b) a review of publicly available policy documents and government websites; and (c) a review of news media.
Results: The implementation of Rory's regulations legally mandated the use of protocols that require timely fluid resuscitation, antibiotic administration, and frequent assessment of hemodynamic response to therapy. At the time, there was evidence to support the efficacy of early detection and treatment of sepsis; however, less was known about the impact of government-mandated regulations (1,2). Although the interplay of institutions, interests, and ideas contributed to the decision to enact Rory's regulations, the passing of Rory Staunton facilitated the passage and limited the negative effects of institutions, interests, and ideas that may otherwise have prevented the passage of Rory's regulations. This analysis highlights potential barriers including (a) failure to justify the need for a policy response, and (b) lack of coordination with existing policies or programs, which could influence decisions against proceeding with sepsis regulations. Given the impact of COVID-19, which can lead to sepsis, and the 2017 WHO resolution that identified sepsis as a global priority, understanding what other countries have done to address sepsis, and the lessons learned is important to identify future policy directions.
Conclusion: We identified and described the institutions, interests, ideas, and external events that aided the passage of Rory's regulations, using the 3I+ E framework. This analysis provides a useful framework for other jurisdictions considering similar policies to identify potential facilitators and barriers and, importantly, to identify next steps to bring sepsis policy to the forefront.
Source: Sheikh F. Journal of Critical Care, 2024 June; 81: 154657
What NICE’s updated sepsis guidance means for you: A nurse specialist explains how more targeted antibiotic use based on level of risk supports antimicrobial stewardship
Abstract: National has been guidance updated on to sepsis ensure treatment antibiotics are being used in a more targeted way for people at higher risk of severe illness or death. The National Institute for Health and Care Excellence (NICE) revised part of its guidance so clinicians can have more time to examine patients who are less severely ill while prioritising antibiotic treatment for those who need it most. Here is what you need to know.
Source: Trivedi S S. Cancer Nursing Practice, 2024 May; 23(3): 10–11
Sepsis epidemiology and prognosis in cancer patients: Preliminary results of a multicenter prospective observational study
Abstract: Introduction and aim: Determination of risk factors for sepsis, focus of sepsis, causative microorganisms and mortality in cancer patients.
Patients and methods: Prospective, observational planned. Patients diagnosed with cancer and hospitalized for any reason, followed for at least 72 h, were included. Demographic data, cancer diagnoses, presence of invasive equipment, chemotherapy and antimicrobial treatment histories of the patients were recorded. Sepsis scores, causative microorganisms, resistance profile and mortality were recorded.
Results: The mean age of 383 patients included in the study was 58 and 62% were male. 84% of the patients were followed up in internal clinics and the most common reason for follow-up was the chemotherapy plan. Non-Hodgkin lymphoma (29%) was the most prevalent kind of hematologic malignancy. During the patients' episode's follow-up, 36 cases of sepsis in 35 patients (9.1%) developed. Patients with sepsis had statistically significantly higher rates of hypertension(p = 0.01), coronary artery disease (p = 0.002), heart failure (p = 0.02), graft versus host disease (GVHD) (p = 0.012), hospitalization in the intensive care unit within the previous three months (p = 0.019), urethral catheter (p < 0.001), central catheter (p = 0.02), galactomannan positivity rate (p = 0.001), 28-day mortality (p < 0.001), and hospitalization in the intensive care unit (p = 0.019). GVHD in multivariate analysis (OR = 30.985 (4.459–215.304), p = 0.001), urethral catheter OR = 4.322 (1.533–12.184), p = 0.006) and CVC (OR = 2.870 (1.155–7.131), p = 0.023) were found to be risk factors for sepsis. Septic shock developed in 19 (52.8%) of the episodes and required ICU in 27 episodes. Treatment was initiated within the first hour in 31 episodes requiring crystalloids. In 33 episodes (91.7%), cultures were taken in the first hour and antibiotic treatment was started. The most common sepsis focus was lung. The causative agent was Gram-negative in 17 out of 23 bacteria isolated from the episodes. Multidrug resistance rate was 65%. The most commonly used antibiotics in empirical treatment were carbapenem (80.6%) and glycopeptides (44.4%). The mean duration of treatment was 10 days and the 28-day mortality rate was 66.7%. In multivariate analysis, it was concluded that the presence of sepsis increased mortality 9.6 times (OR = 9.682 (4.512–20.774), p < 0.001).
Conclusion: This is the first multicenter epidemiology study of sepsis in cancer patients in Turkey. The rate of development of sepsis was 9%, and the presence of GVHD and invasive device was the most important risk factor for sepsis. It was found that the development of sepsis increased the mortality 10 times. Rational use of catheters (if necessary, in accordance with asepsis, short-term) saves lives in cancer patients.
Source: Ture Z. Journal of Critical Care, 2024 June; 81: 154660
Please click on the links below and enter your OpenAthens username and password to download the full text or contact the library at esth.hirsonlibrary@nhs.net to request the full text.
Multimodal Quality Initiatives in Sepsis Care: Assessing Impact on Core Measures and Outcomes
Abstract: Providing timely and effective care for patients with sepsis is challenging due to delays in recognition and intervention. The Surviving Sepsis Campaign has developed bundles that have been shown to reduce sepsis mortality. However, hospitals have not consistently adhered to these bundles, resulting in suboptimal outcomes. To address this, a multimodal quality improvement sepsis program was implemented from 2017 to 2022 in a large urban tertiary hospital. The aim of this program was to enhance the Severe Sepsis and Septic Shock Management Bundle compliance and reduce sepsis mortality. At baseline, the Severe Sepsis and Septic Shock Management Bundle compliance rates were low, at 25%, with a sepsis observed/expected mortality ratio of 1.14. Our interventions included the formation of a multidisciplinary committee, the appointment of sepsis champions, the implementation of sepsis alerts and order sets, the formation of a Code Sepsis team, real-time audits, and peer-to-peer education. By 2022, compliance rose to 62%, and the observed/expected mortality ratio decreased to 0.73. Our approach led to improved outcomes and hospital rankings. These findings underscore the efficacy of a comprehensive sepsis care initiative, emphasizing the importance of interdisciplinary collaboration. A multimodal hospital-wide sepsis performance program is feasible and can contribute to improved outcomes. However, further research is necessary to determine the specific impact of individual strategies on sepsis outcomes.
Source: Garcia M. Journal for Healthcare Quality, 2024 Jul-Aug; 46(4): 245-250
Contact the library for a copy of this article
Sepsis without borders
Abstract: Sepsis is a global public health problem, accounting for 48.9 million cases and 11 million sepsis-related deaths worldwide in 2020, with the highest burden felt in low-income countries (LICs) (World Health Organization (WHO), 2024a). The main challenge is that as a syndrome and not a disease, the range of signs and symptoms seen can make it difficult to diagnose in its early stages. In consequence, health professionals always need to rule out sepsis rather than rule it in, using the question ‘Could it be sepsis?’ (Sepsis Trust, 2024). This comment piece highlights the ongoing nature of the burden of sepsis, as countries continue to grapple with this global problem.
Source: Carter C. British Journal of Nursing, 2024 Jul; 33(14): 654-655
The frequency of sepsis-associated delirium in intensive care unit and its effect on nurse workload
Abstract: Aim: To determine the frequency of sepsis-associated delirium (SAD) in the intensive care unit and its effect on nurse workload.
Design: A cross-sectional and correlational design was used.
Methods: The study was conducted with 158 patients in the adult intensive care unit of a hospital between October 28 and July 28, 2022. Data analysis included frequency, chi-squared/fisher's exact test, independent samples t-test, correlation analysis, simple and multiple linear regression analyses. The study adhered to the STROBE guidelines.
Results: Sepsis was detected in 12.7% of the patients, delirium in 39.9%, and SAD in 10.1%. SAD was more common in males (19%) and 56.3% of the patients were admitted to the unit from the emergency department. Patients developing SAD had significantly higher age and mean sequential organ failure evaluation, acute physiology and chronic health evaluation II, and C-reactive protein and lactate scores, but their Glasgow Coma Scale scores were significantly low. There was a moderate positive relationship between the patients' Sequential Organ Failure Assessment score and the presence of SAD. The most common source of infection in patients diagnosed with SAD was bloodstream infection (44.4%). SAD significantly increased nurse workload and average care time (1.8 h) and it explained 22.8% of the total variance in nurse workload. Additionally, the use of antibiotics, vasopressors and invasive mechanical ventilation significantly increased nurse workload.
Conclusion: In the study, in patients who developed SAD increased nurse workload and average care time significantly. Preventive nursing approaches and effective management of SAD can reduce the rate of development of SAD and nurse workload.
Implications for the profession and patient care: It is important to work with routine screening, prevention and patient–nurse ratio appropriate to the workload for SAD.
Source: Alici S. Journal of Clinical Nursing, 2024 May; Online ahead of print
Emergency clinicians' use of adult and paediatric sepsis pathways: An implementation redesign using the behaviour change wheel
Abstract: Aims: To identify facilitators and barriers and tailor implementation strategies to optimize emergency clinician's use of adult and paediatric sepsis pathways.
Design: A qualitative descriptive study using focus group methodology.
Methods: Twenty-two emergency nurses and ten emergency medical officers from four Australian EDs participated in eight virtual focus groups. Participants were asked about their experiences using the New South Wales Clinical Excellence Commission adult and paediatric sepsis pathways using a semi-structured interview template. Facilitators and barriers to use of the sepsis pathways were categorized using the Theoretical Domains Framework. Tailored interventions were selected to address facilitators and barriers, and a re-implementation plan was devised guided by the Behaviour Change Wheel.
Results: Thirty-two facilitators and 58 barriers were identified corresponding to 11 Theoretical Domains Framework domains. Tailored strategies were selected to optimize emergency clinicians' use of the sepsis pathways including refinement of existing education and training programmes, modifications to the electronic medical record system, introduction of an audit and feedback system, staffing strategies and additional resources.
Conclusion: The implementation of sepsis pathways in the Emergency Department setting is complex, impacted by a multitude of factors requiring tailored strategies to address facilitators and barriers and optimize uptake.
Implications for Patient Care: This study presents a theory-informed systematic approach to successfully implement and embed adult and paediatric sepsis pathways into clinical practice in the Emergency Department.
Impact: Optimizing uptake of sepsis pathways has the potential to improve sepsis recognition and management, subsequently improving the outcome of patients with sepsis.
Reporting Method: The Consolidated Criteria for REporting Qualitative research guided the preparation of this report.
Patient or Public Contribution: Nil.
Source: Munroe B. Journal of Advanced Nursing, 2024 September; Online ahead of print
Predicting sepsis at emergency department triage: Implementing clinical and laboratory markers within the first nursing assessment to enhance diagnostic accuracy
Abstract: Background: Early identification of sepsis in the emergency department (ED) triage is both valuable and challenging. Numerous studies have endeavored to pinpoint clinical and biochemical criteria to assist clinicians in the prompt diagnosis of sepsis, but few studies have assessed the efficacy of these criteria in the ED triage setting. The aim of the study was to explore the accuracy of clinical and laboratory markers evaluated at the triage level in identifying patients with sepsis.
Methods: A prospective study was conducted in a large academic urban hospital, implementing a triage protocol aimed at early identification of septic patients based on clinical and laboratory markers. A multidisciplinary panel of experts reviewed cases to ensure accurate identification of septic patients. Variables analyzed included: Charlson comorbidity index, mean arterial pressure (MAP), partial pressure of carbon dioxide (PetCO2), white cell count, eosinophil count, C-reactive protein to albumin ratio, procalcitonin, and lactate.
Results: A total of 235 patients were included. Multivariable analysis identified procalcitonin ≥1 ng/mL (OR 5.2; p < 0.001); CRP-to-albumin ratio ≥32 (OR 6.6; p < 0.001); PetCO2 ≤ 28 mmHg (OR 2.7; p = 0.031), and MAP <85 mmHg (OR 7.5; p < 0.001) as independent predictors for sepsis. MAP ≥85 mmHg, CRP/albumin ratio <32, and procalcitonin <1 ng/mL demonstrated negative predictive values for sepsis of 90%, 89%, and 88%, respectively.
Conclusions: Our study underscores the significance of procalcitonin and mean arterial pressure, while introducing CRP/albumin ratio and PetCO2 as important variables to consider in the very initial assessment of patients with suspected sepsis in the ED.
Clinical relevance: Early identification of sepsis since the emergency department (ED) triage is challenging Implementing the ED triage protocol with simple clinical and laboratory markers allows to recognize patients with sepsis with a very good discriminatory power (AUC 0.88).
Source: Sisto U G. Journal of Nursing Scholarship, 2024 June; Online ahead of print
Association between measures of resuscitation in the critical care resuscitation unit and in-hospital mortality among patients with sepsis
Abstract: Objectives: We hypothesized that lactate clearance and reduction of the Sequential Organ Failure Assessment (SOFA) score during patients’ critical care resuscitation unit (CCRU) stay would be associated with lower in-hospital mortality.
Methods: This was a retrospective study of adult patients who had sepsis diagnoses and were admitted to the CCRU in 2018. Multivariable logistic regression analysis was performed to assess the association of clinical factors, lactate clearance, and SOFA reduction with hospital mortality.
Results: A total of 401 patients with lactate clearance data and 455 patients with SOFA score data were included in the study. The mean (SD) lactate and SOFA score on admission were 2.2 (1.8) mmol/L and 4.4 (4.3), respectively. Average lactate clearance was 0.1 (2.6) mmol/L, and average SOFA score reduction was 0.65 (5.9). Patients with a one point reduction in SOFA score during their CCRU stay had a 31% reduction of mortality (odds ratio [OR] 0.69, 95% confidence interval [CI] 0.62–0.77, p < 0.001). SOFA score reduction was associated with lower hospital mortality for both surgical patients (OR 0.69, 95% CI 0.58–0.81, p < 0.001) and non-surgical patients (OR 0.71 95% CI 0.06–0.83, p < 0.001).
Conclusion: SOFA score reduction, but not lactate clearance during the CCRU stay, was associated with lower odds of in-hospital mortality. These findings suggest that resuscitative efforts leading to an early improvement in SOFA score may benefit patients with sepsis.
Source: Emamian N. Journal of the American College of Emergency Physicians, 2024 August; 5(5): e13281
Outcomes and prognosis of sepsis and septic shock in critically ill hematology patients
Abstract: Introduction and aim: Hematology patients are at high risk for sepsis/septic shock as a result of both their primary disease and treatment. In this patient population, it is very important to examine the entire course of sepsis/septic shock and to define the affecting factors in order to determine the measures for reducing sepsis-related mortality.
Patients and methods: The patients admitted to hematology intensive care unit (ICU) in a university hospital were retrospectively examined between January 01, 2018 and December 31, 2022. Those followed up with the diagnosis of sepsis/septic shock were included in the study. The demographic characteristics of the patients, comorbidities, reasons for ICU admission, organ failure scores on ICU admission, underlying hematological diseases and the status of diseases, the presence of neutropenia, decubitus wounds, nutritional support, the source of the infection and infectious agents, sepsis/septic shock-related complications and laboratory data were evaluated in detail. The effects of these data on mortality were examined.
Results: A total of 260 sepsis episodes of 149 patients were analyzed. The underlying hematological diseases, 32.8% were acute leukemia, 24.2% multiple meyloma, 20.8% lymphoproliferative disease, 12.1% chronic leukemia and HSCT was performed in 65 patients. The median SOFA score at ICU admission was 9 (7–12) and the APACHE-II median was 25 (20–32). The most common sources of infection were pulmonary infection with a rate of 73.8% and blood stream infection (BSI) with a rate of 42.3%. The ICU mortality rate was 50,3%. The SOFA score at ICU admission, admission from inpatient clinics or other ICUs, presence of neutropenia and decubitus wound, laboratory findings such as procalcitonin (PCT), lactate, creatinine and pH, sepsis/septic shock-related complications, source of infections, culture negativity, and presence of fungal infection were all defined as significant factors affecting mortality in univariate analysis. The admission from inpatient clinics or other ICUs, SOFA score and presence of decubitus wound at ICU admission, not feeding orally or enterally, BSI as a sepsis/septic shock source, and requirement for renal replacement therapy (RRT) were defined as independent variables for ICU mortality in logistic regression analysis (Table 1).
Conclusion: This study showed that the course and prognosis of sepsis/septic shock were determined by presence of organ failure (SOFA score) and decubitus wounds (indirect indicator of performance status), not feeding orally and enterally, and requirement of RRT rather than the variables related to the underlying hematological disease.
Source: Bozkurt H K. Journal of Critical Care, 2024 June; 81: 154653
Contact the library for a copy of this article
Effect of an interdisciplinary sepsis team on the management of patients with sepsis and septic shock in the emergency department: A literature review
Abstract: Introduction and aim: Sepsis is a life-threatening condition which is due to a systematic inflammatory and immune response to an infection. The optimization of the management of patients with sepsis, requires immediate identification, appropriate antibiotic therapy, hemodynamic support, and control of the source of infection. Delayed early identification, and initiation of treatment can lead to septic shock, multiorgan failure, and death. Through the literature, it seems that the existence of an interdisciplinary sepsis team is a factor that contributes significantly to the improvement of sepsis recognition, as well as compliance with the guidelines and consequently to the improvement of patients' outcomes. To investigate the literature regarding the impact of an interdisciplinary sepsis team on the degree of compliance with the Surviving Sepsis Campaign (SSC) guidelines (1-Hour Bundle: whether they are implemented and times) in ERs.
Patients and methods: Α systematic review of the literature in the PubMed and CINAHL databases using specific keywords, inclusion and exclusion criteria. The search was established during the period 2022–2023. NOS tool was used for the quality assessment of the research methodology of the studies included in the current review.
Results: The search resulted in a total of 9 studies published during the period 2017–2022. 4 of them were retrospective, 1 cohort, 1 quasi-experimental, 2 retrospective and prospective studies and 1 prospective study. The results show a statistically significant improvement in compliance with sepsis guidelines within 1 h in taking blood cultures before giving antibiotics (40% to 85%), administration of broad-spectrum antibiotics (25% to 76.9%), administration of crystalloid intravenous fluids (30 ml/kg BW), (31% to 81%), administration of vasopressors drugs if hypotension persists after administration of intravenous fluids (43% to 58%), in measurement of 1st lactate (13% to 47%), and 2nd lactic acid (76% to 90%) within 3 h.
Conclusion: Interdisciplinary sepsis management teams can use existing knowledge, skills and tools to improve sepsis compliance by improving the processing time of measures, such as improving the time to measure lactate, administer fluids, take blood cultures and administer antibiotics.
Source: Georgiou C. Journal of Critical Care, 2024 June; 81: 154666
Contact the library for a copy of this article
Effect of antibiotics efficacy in patients with sepsis and septic shock presenting in the emergency department: A literature review
Abstract: Introduction and aim: Sepsis is a life-threatening condition which is due to a systematic inflammatory and immune response to an infection. Patients comes in Emergency Department (ERs) with infections that could lead in sepsis and septic shock. Approximately 50 million patients develop severe sepsis and septic shock worldwide. More than half are admitted to an intensive care unit (ICU). Early diagnosis and treatment of these patients is critical and is associated not only with improved morbidity and mortality, but also with reduced length of hospital stay (LOS). As a consequence of the immediate recognition of sepsis, the timely administration of antibiotics is a necessary condition for its effective treatment. To investigate the literature regarding the effectiveness of timely administration of antibiotics in patients with sepsis in the ERs.
Patients and methods: Α systematic review of the literature in the PubMed and CINAHL databases. All possible combinations have been using the word “andâ€. Study Inclusion criteria were: a) studies examining the timely administration of antibiotics in septic patients, b) studies correlating the time of antibiotic administration and in-hospital mortality, c) published in scientific journals in English, the last 5 years.
Results: The search resulted in a total of 7 studies. 4 from Asia, 2 from USA and 1 from United Kingdom, that were published between 2017 and 2022. It is argued that the untimely administration of antibiotics increases mortality. In-hospital mortality rates were reduced in patients receiving antibiotics within 1 h (30% to 18%), (p < 0,001) compared to those who did not receive the timely treatment (20% to 55%) (p = 0.046), (p = 0.009). Among patients who received antibiotics within the appropriate time showed 35% (p = 0.042), (p < 0,001) increased risk of mortality for every 1 h delay in antibiotics.
Conclusion: Early administration of antibiotics improves outcomes in patients with sepsis and septic shock. Delays in the initiation of antibiotics in the emergency department are associated with a clinically significant increase in the risk of mortality from sepsis. The need to improve the timely treatment of patients with sepsis who come to the ERs is emphasized.
Source: Georgiou C. Journal of Critical Care, 2024 June; 81: 154667
Contact the library for a copy of this article
Recognition, diagnosis, and early management of suspected sepsis: summary of updated NICE guidance
Abstract: What you need to know: Calculate NEWS2 scores to determine an adult’s risk of severe illness or death from sepsis in acute hospital, mental health, and ambulance settings. Use the person’s risk level to help determine the time window in which to give antibiotics.
Sepsis is defined as life threatening organ dysfunction caused by a dysregulated host response to infection.1 In 2016, the National Institute for Health and Care Excellence (NICE) first published guidance on recognising, diagnosing, and managing suspected sepsis. [...]in January 2024, NICE guidance was updated to include NEWS2 for stratifying risk of severe illness or death from sepsis.4 The updated guideline aims to ensure that early recognition of patient deterioration and treatment for sepsis becomes standardised nationally, and includes recommendations on the timing of antibiotic prescribing based on a person’s risk level, while investigating the underlying infection source. Evaluating risk level using NEWS2 A new recommendation was made that NEWS2 scores should be recorded for all patients aged 16 and over (excluding people who are or have recently been pregnant) in acute hospital, mental health, and ambulance settings to help stratify risk of severe illness or death from sepsis. Deferring administration of a broad spectrum antibiotic treatment for up to three hours after calculating the person’s first NEWS2 score on initial assessment in the emergency department or deterioration in the ward, and using this time to gather information for a more specific diagnosis. Discussing the person’s condition with a senior clinical decision maker.
Source: Gildea A. BMJ, 2024 June; 385: q1173
Fluid Resuscitation and Sepsis Management in Patients with Chronic Kidney Disease Or Endstage Renal Disease: Scoping Review
Abstract: Managing sepsis and fluid resuscitation in patients with chronic kidney disease or end-stage renal disease is challenging for health care providers. Nurses are essential for early identification and treatment of these patients. Nurse education on assessing perfusion and implementing 3-hour bundled care can improve mortality rates in patients with sepsis. In this scoping review, initial screening identified 1176 articles published from 2015 through 2023 in the National Library of Medicine database; 29 articles were included in the literature summary and evidence synthesis. A systematic review meta-analysis was not possible because of data heterogeneity. The review revealed that most patients with chronic kidney disease or end-stage renal disease received more conservative resuscitation than did the general population, most likely because of concerns about volume overload. However, patients with chronic kidney disease or end-stage renal disease could tolerate the standard initial fluid resuscitation bolus of 30 mL/kg for sepsis. Outcomes in patients with chronic kidney disease or end-stage renal disease were similar to outcomes in patients without those conditions, whether they received standard or conservative fluid resuscitation. Patients who received the standard (higher) fluid resuscitation volume did not have increased rates of complications such as longer duration of mechanical ventilation, increased mortality, or prolonged length of stay. Using fluid responsiveness to guide resuscitation was associated with improved outcomes. The standard initial fluid resuscitation bolus of 30 mL/kg may be safe for patients with chronic kidney disease or end-stage renal disease and sepsis. Fluid responsiveness could be a valuable resuscitation criterion, promoting better decision-making by multidisciplinary teams. Further research is required.
Source: Haley M. American Journal of Critical Care, 2024 January; 33(1): 45-53
Clinical evaluation of different sepsis filters
Abstract: Introduction and aim: Sepsis is a life-threatening organ dysfunction in response to a host's infection. In addition to treatments with proven efficacy in sepsis, there are also treatment methods under investigation. The use of cytokine filters is recognized as a promising adjunctive therapy in the treatment of sepsis. The aim of this study is to evaluate the results of sepsis cytokine filters applied in sepsis patients.
Patients and methods: In this retrospective single center study, 17 patients who were followed up in the Internal Diseases Intensive Care Clinic of Kayseri City Hospital due to sepsis and were applied sepsis cytokine filter were included in the study. Three sepsis filters were applied to the patients according to their clinical status. CPFA sepsis filter was applied in 5 patients(Group 1), Oxiris in 7 patients(Group 2), and Jafron HA330 in 5 patients(Group 3).ResultsThe mean age of the patients was 67.1 ± 17.9 years. Seven of the patients were femal (41%) and 10 were male(59%). The hospitalization period of the patients was 30.1 ± 32.3 days and the day of hospitalization in the intensive care unit was 11.1 ± 8.8 days. The mean APACHE value of the patients was 32.8 ± 7.1 and the hospitalization glaskow coma score was 10.3 ± 3.3. There was a significant difference between the glaskow coma score at the intensive care unit admission and the glaskow coma score at the time of discharge from the intensive care unit (p = 0.010). CRP decrease rates and procalcitonin decrease rates before and after sepsis filter were significant, but WBC decrease rate was not significant (p < 0.001, p = 0.001, and p = 0.570, respectively). Procalcitonin decrease percentages of the patients were 0.87 ± 0.15, and CRP decrease percentages were 0.64 ± 0.31. The percentages of decrease in Procalcitonin were found to be significant in the CPFA sepsis filter applied group compared to the groups in which Oxiris and Jafron HA330 were applied (p = 0.020), there was no difference between the three groups in terms of CRP decrease percentages (p = 0.755). There was no difference in mortality between the groups.
Conclusion: Sepsis cytokine filters have been shown in many studies to contribute positively to reducing procalcitonin and CRP values. It has been reported that cytokine filters used in selected sepsis patients have positive effects on mortality. The significant decrease in the percentage of procalcitonin in CPFA may be due to the smaller pore size. Studies to be conducted in larger patient groups will be appropriate in terms of evaluating the effect on mortality.
Source: Sirakaya H A. Journal of Critical Care, 2024 June; 81: 154719
Contact the library for a copy of this article
Can Artificial Intelligence and Machine Learning Techniques improve the ability to detect Sepsis and Septic Shock. A retrospective study of 218,562 adult patients in a university hospital
Abstract: Introduction and aim: The use of Artificial Intelligence (AI) and Machine Learning (ML) techniques has improved a sepsis (SE) and septic shock (SS) early detection compared with traditional rules according to recent retrospective, prospective and meta-analysis (1). Develop predictive models using algorithms based on AI-ML techniques and compare with fixed rules for SE/SS detection, assessing whether these new models improve predictive capability.
Methods: We carried out an observational, retrospective non interventional study developed in our University General Hospital. The period assessed was from January 2014 to October 2018. The diagnosis and validation of each SE or SS case were made prospectively by the clinical experts of the Multidisciplinary Sepsis Unit (MSU). We used a Sepsis 2 definition. We developed AI-ML techniques from historical data from the Electronic Health Record (EHR). The structured variables were obtained from different data sources and from non-structured text from the Triage and Emergency Department (ED). The Mann-Whitney-Wilcoxon test was used to identify statistically significant clinical and analytical variables, as well as wrapper techniques, with a significance level of 0.01 and to obtain relevant unstructured data using a Natural Language Processing (NLP) techniques.
Results: A total of 815,170 records of the EHR have been assessed. We included 218.562 adult patients from all hospital departments. We divided into 2 groups: 1) with SE/SS were 9301 (4.6%); and 2) 209,261 (95.4%) who did NOT have sepsis (NSE). A total of 3927 variables have been extracted from the different data sources. By relevance and after being validated by the UMS team, 244 (6.2%) both structured and unstructured variables were associated with the detection of SE/SS. Within the structured variables, we identified many that are not blackened by the classic scorings of SE/SS, such as hemoglobin or eosinopenia. We developed about 30 different predictive models for SE/SS detection, using fixed rules individually, using only AI-ML based algorithms or the combination of fixed rules with AI-ML techniques. The best model using only fixed rules was the one using the Sepsis.2 criterion, while the best model using AI-ML techniques was called BISEPRO and was a combination of SEPSIS.2 with AI-ML techniques.
Conclusion: In this retrospective study including adult patients in all areas of a hospital the use of AI-ML based techniques was significantly superior for the detection of SE/SS.
Source: Gonzalez V L H. Journal of Critical Care, 2024 June; 81: 154684
Contact the library for a copy of this article
Hemodynamic profile of cirrhotic patients with sepsis and septic shock: A propensity score matched case-control study
Abstract: Purpose: Our understanding of hemodynamics in cirrhotic patients with sepsis remains limited. Our study aims to investigate differences in hemodynamic profiles using echocardiography between septic patients with and without cirrhosis.
Materials and methods: This is a single-center, retrospective study of septic patients with echocardiogram within 3 days of ICU admission. We compared baseline characteristics, echocardiographic markers of LV systolic function arterial load between patients with and without cirrhosis. A propensity score-matched case-control model was developed to describe the differences in those echocardiography derived parameters between the groups.
Results: 3151 patients with sepsis were included of which 422 (13%) had cirrhosis. In the propensity score matched group with 828 patients, cirrhotic patients had significantly higher left ventricular ejection fraction (64 vs.56%, p < 0.001) and stroke volume (72 vs.48 ml, p < 0.001) along with lower arterial elastance (Ea) (1.35 1vs.20.3, p < 0.001) and systemic vascular resistance (SVR) (851 vs.1209 dynes/s/m−5, p = 0.001). The left ventricular elastance (Ees) (2.83 vs 2.45, p = 0.002) was higher and ventricular-arterial coupling (Ea/Ees) (0.48 vs. 0.86, p < 0.001) lower in cirrhotic compared to non-cirrhotic.
Conclusions: Septic patients with cirrhosis had higher LVEF with lower Ea and SVR with higher Ees and significantly lower Ea/Ees suggesting vasodilation as the principal driver of the hyperdynamic profile in cirrhosis.
Source: You J Y. Journal of Critical Care, 2024 June; 81: 154532
Contact the library for a copy of this article
Time Is Survival: Continuing Education on Sepsis for Neurosurgical Critical Care Nurses
Abstract: Background: Early identification of sepsis among neurosurgical critical care patients is a significant challenge because of the many possible confounding variables that lead to altered mental status in this specific patient population. Nurses' knowledge, attitudes, confidence, and practices related to the early identification and management of sepsis are crucial to patients' survival.
Method: This evidence-based intervention project implemented continuing education for neurosurgical critical care nurses on the early signs and symptoms of sepsis and the management of sepsis according to the Surviving Sepsis Campaign (SSC) Guidelines.
Results: Continuing education on sepsis increased neurosurgical critical care nurses' knowledge of the SSC 1-hour sepsis bundle, reported confidence in the management of sepsis, and likelihood of assessing for sepsis.
Conclusion: Continuing education for neurosurgical critical care nurses on the signs and symptoms of sepsis and the SSC Guidelines is necessary and may improve patient outcomes.
Source: Rios E M. Journal of Continuing Education in Nursing, 2024 May; 55(5): 224–230
Previously healthy adults among septic patients: Population-level epidemiology and outcomes
Abstract: Purpose: Previously healthy adults with community-onset sepsis were recently reported to have, counterintuitively, higher short-term mortality than those with comorbid conditions. However, the population-level generalizability of this finding and its applicability to all hospitalized septic patients are unclear.
Methods: We used a statewide dataset to identify hospitalizations aged ≥18 years with a diagnosis of sepsis in Texas during 2018–2019. Comorbidities were defined as those included in the Charlson Comorbidity Index and other prevalent conditions associated with mortality. Hierarchical models were used to estimate the association of comorbid state with short-term mortality (defined as in-hospital mortality or discharge to hospice), overall and in community-onset and hospital-onset sepsis.
Results: Among 120,371 sepsis hospitalizations, 6611 (5.5%) were previously healthy and 105,455 (87.6%) had community-onset sepsis. Short-term mortality among the previously healthy and those with comorbidities was 11.7% vs 28.2% overall, 11.0% vs 25.2% in community-onset sepsis, and 22.0% vs 48.7% in hospital-onset sepsis, respectively. On adjusted analysis, being previously healthy remained associated with lower short-term mortality overall (adjusted odds ratio 0.62 [95% CI 0.57–0.69]), with findings consistent with the primary analysis in community-onset sepsis, hospital-onset sepsis.
Conclusions: Previously healthy septic patients had lower short-term mortality compared to those with comorbid conditions.
Source: Oud L. Journal of Critical Care, 2024 February; 79: 154427
Contact the library for a copy of this article
Early prediction of sepsis in intensive care patients using the machine learning algorithm NAVOY® Sepsis, a prospective randomized clinical validation study
Abstract: Purpose: To prospectively validate, in an ICU setting, the prognostic accuracy of the sepsis prediction algorithm NAVOY® Sepsis which uses 4 h of input for routinely collected vital parameters, blood gas values, and lab values.
Materials and methods: Patients 18 years or older admitted to the ICU at Skåne University Hospital Malmö from December 2020 to September 2021 were recruited in the study. A total of 304 patients were randomized into one of two groups: Algorithm group with active sepsis alerts, or Standard of care. NAVOY® Sepsis made silent predictions in the Standard of care group, in order to evaluate its performance without disturbing the outcome. The study was blinded, i.e., study personnel did not know to which group patients were randomized. The healthcare provider followed standard practices in assessing possible development of sepsis and intervening accordingly. The patients were followed-up in the study until ICU discharge.
Results: NAVOY® Sepsis could predict the development of sepsis, according to the Sepsis-3 criteria, three hours before sepsis onset with high performance: accuracy 0.79; sensitivity 0.80; and specificity 0.78.
Conclusions: The accuracy, sensitivity, and specificity were all high, validating the prognostic accuracy of NAVOY® Sepsis in an ICU setting, including Covid-19 patients.
Source: Persson I. Journal of Critical Care, 2024 April; 80: 154400
Embracing a New Evidence-Based Thought Paradigm of Sepsis
Abstract: In 1991, sepsis was first defined by the Society of Critical Care Medicine as the systemic inflammatory response syndrome, in the presence of infection. Systemic inflammatory response syndrome is an adaptive host response to infection, as well as to other insults like trauma and stress. Research pertaining to sepsis was guided by this adaptive definition for 25 years. After established guidelines for sepsis management were challenged in 2014, sepsis was redefined in 2016 as a dysregulated host response to infection. However, there still remains no consensus on which immunologic or metabolic mechanisms have become dysregulated. We sought to examine sepsis literature published after the 2016 consensus definition and compare it to the original systemic inflammatory response syndrome paradigm proposed in 1991. The purpose of this intensive analysis was to recommend a new sepsis archetype, with consideration to dysregulated immunologic and metabolic mechanisms that have recently been identified in sepsis. Nurses and other clinicians must shift their thought paradigm toward an evidence-based dysregulated model, in order to improve on sepsis recognition and management.
Source: Richardson L. Clinical Nurse Specialist, 2024 Jul – Aug; 38(4): 171–174
Burden of sepsis in critically ill children with cancer: A retrospective study
Abstract: Introduction and aim: The mortality of pediatric intensive care unit is 27.8% globally and its even higher, i.e. 46.2% in children with sepsis. Children with cancer suffer higher incidence as well as severity of sepsis. Five-year survival of children with cancer has tremendously improved to 83% and two thirds of them require at least one intensive care admission throughout their disease course. Sepsis is the commonest cause of admission and death in intensive care (ICU).We aim to review mortality in critically ill children with cancer with respect to sepsis and its causative microorganisms.
Patients and methods: We retrospectively studied all pediatric admissions to ICU during the period from 1st January 2022 to 31st December 2022 in a tertiary cancer hospital in Mumbai, India. The primary outcome was ICU mortality in this cohort and secondary outcomes included proportion of children admitted with sepsis, suspected source of sepsis, culture results with special focus on ESKAPE organisms (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumanii, Pseudomonas aeruginosa, Enterobacter species).
Results: Over a period of 12 months, 386 children (0–18 years) had 513 admissions in our ICU, with 138 girls (35.8%) and 248 males (64.2%). The ICU mortality was 22.5%. Two hundred and twenty four (58%) patients were admitted with sepsis, out of which 82 patients had culture positive results in one or more samples such as blood, bronchoalveolar lavage, cerebrospinal fluid, etc. The ESKAPE organisms constituted most of the culture isolates with Escherichia coli being the most common, followed by Klebsiella and Pseudomonas. Nearly half of the children (42/82) with positive culture results died as opposed to one fourth mortality in children with culture negative results (32/141). The gram-negative bacilli exhibited a high incidence of carbapenem resistance. Overall incidence of gram-positive infections was low. Viral and fungal infections were diagnosed more clinically or radiologically, or using molecular testing, serum biomarkers as opposed to culture testing.
Conclusions: Sepsis with ESKAPE organism is a major concern in critically ill children with cancer. The high mortality and rising antimicrobial resistance demand focus on tailoring research to improve outcomes in this patient population.
Source: Sharma S. Journal of Critical Care, June 2024; 81: 154599
Contact the library for a copy of this article
Analysis of the factors that contributed to the passage of Rory's regulations using the 3I + E framework: Implications for future sepsis policy
Abstract: Introduction and aim: Sepsis is the dysregulated host response to an infection, accounting for an estimated 48.9 million cases and 11 million sepsis-related deaths worldwide. In 2013, New York State passed Rory's Regulations, requiring all hospitals to develop protocols for early identification and treatment of sepsis. The purpose of this analysis is to (a) identify and describe the ideas, interests, and institutions that led to the New York State Sepsis Regulations; and (b) the implications for future sepsis policy.
Methods: This study was a retrospective document analysis using qualitative description. To guide this policy analysis, the framework was utilized. This framework includes consideration of institutions, interests, ideas, and external factors and is the most appropriate methodology to identify the factors that contribute to the development of a policy. To identify relevant sources of information, we conducted (a) a literature search of academic databases; (b) a review of publicly available policy documents and government websites; and (c) a review of news media.
Results: The implementation of Rory's regulations legally mandated the use of protocols that require timely fluid resuscitation, antibiotic administration, and frequent assessment of hemodynamic response to therapy. At the time, there was evidence to support the efficacy of early detection and treatment of sepsis; however, less was known about the impact of government-mandated regulations (1,2). Although the interplay of institutions, interests, and ideas contributed to the decision to enact Rory's regulations, the passing of Rory Staunton facilitated the passage and limited the negative effects of institutions, interests, and ideas that may otherwise have prevented the passage of Rory's regulations. This analysis highlights potential barriers including (a) failure to justify the need for a policy response, and (b) lack of coordination with existing policies or programs, which could influence decisions against proceeding with sepsis regulations. Given the impact of COVID-19, which can lead to sepsis, and the 2017 WHO resolution that identified sepsis as a global priority, understanding what other countries have done to address sepsis, and the lessons learned is important to identify future policy directions.
Conclusion: We identified and described the institutions, interests, ideas, and external events that aided the passage of Rory's regulations, using the 3I+ E framework. This analysis provides a useful framework for other jurisdictions considering similar policies to identify potential facilitators and barriers and, importantly, to identify next steps to bring sepsis policy to the forefront.
Source: Sheikh F. Journal of Critical Care, 2024 June; 81: 154657
What NICE’s updated sepsis guidance means for you: A nurse specialist explains how more targeted antibiotic use based on level of risk supports antimicrobial stewardship
Abstract: National has been guidance updated on to sepsis ensure treatment antibiotics are being used in a more targeted way for people at higher risk of severe illness or death. The National Institute for Health and Care Excellence (NICE) revised part of its guidance so clinicians can have more time to examine patients who are less severely ill while prioritising antibiotic treatment for those who need it most. Here is what you need to know.
Source: Trivedi S S. Cancer Nursing Practice, 2024 May; 23(3): 10–11
Sepsis epidemiology and prognosis in cancer patients: Preliminary results of a multicenter prospective observational study
Abstract: Introduction and aim: Determination of risk factors for sepsis, focus of sepsis, causative microorganisms and mortality in cancer patients.
Patients and methods: Prospective, observational planned. Patients diagnosed with cancer and hospitalized for any reason, followed for at least 72 h, were included. Demographic data, cancer diagnoses, presence of invasive equipment, chemotherapy and antimicrobial treatment histories of the patients were recorded. Sepsis scores, causative microorganisms, resistance profile and mortality were recorded.
Results: The mean age of 383 patients included in the study was 58 and 62% were male. 84% of the patients were followed up in internal clinics and the most common reason for follow-up was the chemotherapy plan. Non-Hodgkin lymphoma (29%) was the most prevalent kind of hematologic malignancy. During the patients' episode's follow-up, 36 cases of sepsis in 35 patients (9.1%) developed. Patients with sepsis had statistically significantly higher rates of hypertension(p = 0.01), coronary artery disease (p = 0.002), heart failure (p = 0.02), graft versus host disease (GVHD) (p = 0.012), hospitalization in the intensive care unit within the previous three months (p = 0.019), urethral catheter (p < 0.001), central catheter (p = 0.02), galactomannan positivity rate (p = 0.001), 28-day mortality (p < 0.001), and hospitalization in the intensive care unit (p = 0.019). GVHD in multivariate analysis (OR = 30.985 (4.459–215.304), p = 0.001), urethral catheter OR = 4.322 (1.533–12.184), p = 0.006) and CVC (OR = 2.870 (1.155–7.131), p = 0.023) were found to be risk factors for sepsis. Septic shock developed in 19 (52.8%) of the episodes and required ICU in 27 episodes. Treatment was initiated within the first hour in 31 episodes requiring crystalloids. In 33 episodes (91.7%), cultures were taken in the first hour and antibiotic treatment was started. The most common sepsis focus was lung. The causative agent was Gram-negative in 17 out of 23 bacteria isolated from the episodes. Multidrug resistance rate was 65%. The most commonly used antibiotics in empirical treatment were carbapenem (80.6%) and glycopeptides (44.4%). The mean duration of treatment was 10 days and the 28-day mortality rate was 66.7%. In multivariate analysis, it was concluded that the presence of sepsis increased mortality 9.6 times (OR = 9.682 (4.512–20.774), p < 0.001).
Conclusion: This is the first multicenter epidemiology study of sepsis in cancer patients in Turkey. The rate of development of sepsis was 9%, and the presence of GVHD and invasive device was the most important risk factor for sepsis. It was found that the development of sepsis increased the mortality 10 times. Rational use of catheters (if necessary, in accordance with asepsis, short-term) saves lives in cancer patients.
Source: Ture Z. Journal of Critical Care, 2024 June; 81: 154660
Subscribe to:
Posts (Atom)