NUR 611 Literature Review and Evidence Matrix Assignment

Sample Answer

Identifying and promptly addressing sepsis leads to better patient outcomes in comparison to septic shock. Individuals diagnosed with sepsis, particularly those experiencing septic shock, are swiftly transferred to intensive care units to receive the necessary medical assistance and monitoring. The patient’s management involves administering intravenous fluids, conducting dynamic volume assessments, prescribing antibiotics, administering blood pressure medications, and providing mechanical ventilation.

For optimal outcomes, promptly initiating antibiotic therapy in cases of bacterial sepsis is crucial. Source control may be required to address sepsis, such as draining infected fluid collection. Early diagnosis is vital for effective treatment of sepsis. This paper aims to comprehensively review the literature on identifying sepsis as a clinical problem for healthcare professionals and provide a detailed evidence matrix table.

Literature Review

The Chua et al. (2022) research sought to determine the variables impacting the knowledge of registered nurses on sepsis recognition and management, as well as to evaluate their knowledge and confidence in this area. A cross-sectional survey was undertaken among 709 nurses in Singapore’s inpatient and emergency departments. The findings indicated that nurses had a modest knowledge of sepsis and felt confident identifying and addressing sepsis patients.

However, only 369 individuals were able to identify sepsis accurately. Nurses’ knowledge about sepsis significantly correlates with their job grade, educational level, and clinical experience. Results from the sepsis knowledge test showed a little optimistic correlation with self-confidence. The study found that to increase nurses’ capacity to identify and treat sepsis patients, sepsis training and education programs and the use of sepsis screening instruments and care bundles are required.

Along the same line, the research conducted by Nesa et al. (2020) assessed the diagnostic significance of blood levels of C-reactive protein, interleukin-6, tumor necrosis factor-α, and procalcitonin in promptly detecting newborn sepsis. The research was conducted on 90 newborns hospitalized in the particular baby care unit at BIRDEM General Hospital in Dhaka from November 2018 to April 2019.

The findings indicated that TNF-α, CRP, IL-6, and PCT levels in the serum were markedly elevated in the confirmed and probable sepsis groups compared to the no sepsis groups. The serum PCT was the most sensitive and specific biomarker compared to C-reactive protein and TNF-α- for diagnosing newborn septicemia. The research determined that IL-6 and PCT are more accurate and precise indicators than TNF-α and CRP in diagnosing newborn sepsis.

Additionally, the research conducted by Ruangsomboon et al. (2021) sought to assess the effectiveness of the Rapid Emergency Medicine Score (REMS) in predicting mortality in individuals suspected of sepsis in the ED by comparing it with other early warning scores (EWSs). The research included 1622 adult patients observed from August 2018 to July 2019. Out of these patients, 457 individuals, accounting for 28.2% of the total, passed away before being discharged from the hospital.

The REMS scoring system had the most remarkable ability to distinguish in-hospital mortality, with an AUROC of 0.62, considerably higher than both qSOFA and SIRS. However, it was not significantly better than NEWS. REMS demonstrated superior calibration and relationship with the result, making it the most effective EWS. Additionally, it had the most significant net benefit according to decision curve analysis. The study discovered sepsis-related ratings like NEWS were less accurate than the early warning score REMS. Additionally, REMS had the best net benefit utility compared to other early warning scores.

Finally, in their study, Sanguanwit et al. (2024) sought to investigate the factors that predict the mortality rate after 28 days for elderly patients in the emergency room who may have sepsis. A retrospective cohort research was conducted between October 2018 and December 2018, including data collection from 329 older adults. The 28-day mortality rate was 10.33%. Patients with an oxygen saturation level of less than or equal to 93%, a dependent status, and a malignancy had a significantly higher risk of death within 28 days.

These factors were identified as independent prognostic variables strongly associated with mortality. Numerous crucial factors were found in the study to be highly predictive of 28-day mortality in older emergency department patients suspected of having sepsis. These indicators include the presence of malignancy, oxygen saturation levels of 93% or below, and being in a dependent state.

Conclusion

Sepsis is a substantial worldwide health problem characterized by a consistent increase in fatality rates. Early goal-directed therapy does not provide benefits compared to usual care, whereas timely delivery of antibiotics and IV fluids is essential for successful treatment. The revised criteria prioritize organ failure and discourage the use of words such as “systemic inflammatory response syndrome” along with “severe sepsis.” Early detection and suitable therapies enhance the likelihood of survival.

A correlation exists between implementing performance improvement programs, increased adherence to sepsis bundles, and reduced fatality rates. Retrospective research is considered the most dependable way for promptly identifying sepsis owing to its direct methodology, accurate assessment of outcome factors, prolonged monitoring time, extensive sample size, substantial statistical strength, and shortened study length.

References

• Chua, W. L., Teh, C. S., Basri, M. a. B. A., Ong, S. T., Phang, N. Q. Q., & Goh, E. L. (2022). Nurses’ knowledge and confidence in recognizing and managing patients with sepsis A multi‐site cross‐sectional study. Journal of Advanced Nursing, 79(2), 616–629. https //doi.org/10.1111/jan.15435
• Nesa, A., Yesmin, F., & Muttalib, M. A. (2020). Biochemical and immunological markers for the early diagnosis of neonatal septicemia. Bangladesh Medical Research Council Bulletin, 46(2), 83–89. https //doi.org/10.3329/bmrcb.v46i2.49016
• Ruangsomboon, O., Boonmee, P., Limsuwat, C., Chakorn, T., & Monsomboon, A. (2021). The utility of the rapid emergency medicine score (REMS) compared with SIRS, qSOFA, and NEWS for Predicting in-hospital Mortality among Patients with suspicion of Sepsis in an emergency department. BMC Emergency Medicine, 21(1). https //doi.org/10.1186/s12873-020-00396-x
• Sanguanwit, P., Yuksen, C., Khorana, J., Phootothum, Y., Damdin, S., & Sutham, K. (2024). Factors for predicting 28‐day mortality in older patients suspected of having sepsis in the emergency department. Hong Kong Journal of Emergency Medicine. https //doi.org/10.1002/hkj2.12023