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https://www.readbyqxmd.com/read/27908335/the-past-present-and-future-of-the-centers-for-medicare-and-medicaid-services-quality-measure-sep-1-the-early-management-bundle-for-severe-sepsis-septic-shock
#1
REVIEW
Jeremy S Faust, Scott D Weingart
SEP-1, the new national quality measure on sepsis, resulted from an undertaking to standardize care for severe sepsis and septic shock regardless of the size of the emergency department where the patient is being treated. SEP-1 does not necessarily follow the best current evidence available. Nevertheless, a thorough understanding of SEP-1 is crucial because all hospitals and emergency providers will be accountable for meeting the requirements of this measure. SEP-1 is the first national quality measure on early management of sepsis care...
February 2017: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/27908334/antimicrobial-stewardship-in-the-management-of-sepsis
#2
REVIEW
Michael S Pulia, Robert Redwood, Brian Sharp
Sepsis represents a unique clinical dilemma with regard to antimicrobial stewardship. The standard approach to suspected sepsis in the emergency department centers on fluid resuscitation and timely broad-spectrum antimicrobials. The lack of gold standard diagnostics and evolving definitions for sepsis introduce a significant degree of diagnostic uncertainty that may raise the potential for inappropriate antimicrobial prescribing. Intervention bundles that combine traditional quality improvement strategies with emerging electronic health record-based clinical decision support tools and rapid molecular diagnostics represent the most promising approach to enhancing antimicrobial stewardship in the management of suspected sepsis in the emergency department...
February 2017: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/27907062/sepsis-prevalence-and-outcome-on-the-general-wards-and-emergency-departments-in-wales-results-of-a-multi-centre-observational-point-prevalence-study
#3
Tamas Szakmany, Robert M Lundin, Ben Sharif, Gemma Ellis, Paul Morgan, Maja Kopczynska, Amrit Dhadda, Charlotte Mann, Danielle Donoghue, Sarah Rollason, Emma Brownlow, Francesca Hill, Grace Carr, Hannah Turley, James Hassall, James Lloyd, Llywela Davies, Michael Atkinson, Molly Jones, Nerys Jones, Rhodri Martin, Yousef Ibrahim, Judith E Hall
Data on sepsis prevalence on the general wards is lacking on the UK and in the developed world. We conducted a multicentre, prospective, observational study of the prevalence of patients with sepsis or severe sepsis on the general wards and Emergency Departments (ED) in Wales. During the 24-hour study period all patients with NEWS≥3 were screened for presence of 2 or more SIRS criteria. To be eligible for inclusion, patients had to have a high clinical suspicion of an infection, together with a systemic inflammatory response (sepsis) and evidence of acute organ dysfunction and/or shock (severe sepsis)...
2016: PloS One
https://www.readbyqxmd.com/read/27882794/assessment-and-management-of-the-septic-patient-part-2
#4
Jody Vaughan, Andy Parry
Sepsis has gained increasing publicity in recent years, and there is now a strong focus of clinical education and training following the Surviving Sepsis Campaign. The assessment and management of a septic patients is far from simple and requires a systematic approach in both identifying and managing the condition. This second part explores sepsis care bundles and the research that underpins each of the interventions. These discussions will enable nurses to understand why each component of the sepsis care bundle is important and thus enable them to rapidly prioritise care, as early effective interventions have been shown to optimise patient outcomes...
November 24, 2016: British Journal of Nursing: BJN
https://www.readbyqxmd.com/read/27852320/a-complex-endeavour-an-ethnographic-study-of-the-implementation-of-the-sepsis-six-clinical-care-bundle
#5
Carolyn Tarrant, Barbara O'Donnell, Graham Martin, Julian Bion, Alison Hunter, Kevin D Rooney
BACKGROUND: Implementation of the 'Sepsis Six' clinical care bundle within an hour of recognition of sepsis is recommended as an approach to reduce mortality in patients with sepsis, but achieving reliable delivery of the bundle has proved challenging. There remains little understanding of the barriers to reliable implementation of bundle components. We examined frontline clinical practice in implementing the Sepsis Six. METHODS: We conducted an ethnographic study in six hospitals participating in the Scottish Patient Safety Programme Sepsis collaborative...
November 16, 2016: Implementation Science: IS
https://www.readbyqxmd.com/read/27851111/1475-assessment-of-noncompliance-with-bundle-therapy-for-the-treatment-of-sepsis-on-the-inpatient-floor
#6
Paige DeLuca, Shereef Ali, Anthony Fryckberg, Nikunj Vyas
No abstract text is available yet for this article.
December 2016: Critical Care Medicine
https://www.readbyqxmd.com/read/27851062/1426-bundle-compliance-effect-greater-in-hemodynamically-stable-sepsis-patients-with-intermediate-lactate
#7
Daniel Leisman, Jason D'Amore, Jeanie Gribben, Mary Ward, John D'Angelo, Kevin Masick, Martin Doerfler
No abstract text is available yet for this article.
December 2016: Critical Care Medicine
https://www.readbyqxmd.com/read/27851052/1416-the-effect-of-providing-clinical-performance-feedback-on-compliance-with-sepsis-treatment-bundles
#8
Joanne Wozniak, James Dargin
No abstract text is available yet for this article.
December 2016: Critical Care Medicine
https://www.readbyqxmd.com/read/27851051/1415-the-effect-of-providing-clinical-performance-feedback-on-compliance-with-sepsis-treatment-bundles
#9
Joanne Wozniak, James Dargin
No abstract text is available yet for this article.
December 2016: Critical Care Medicine
https://www.readbyqxmd.com/read/27847192/trends-in-1029-trauma-deaths-at-a-level-1-trauma-center-impact-of-a-bleeding-control-bundle-of-care
#10
Blessing T Oyeniyi, Erin E Fox, Michelle Scerbo, Jeffrey S Tomasek, Charles E Wade, John B Holcomb
BACKGROUND: Over the last decade the age of trauma patients and injury mortality has increased. At the same time, many centers have implemented multiple interventions focused on improved hemorrhage control, effectively resulting in a bleeding control bundle of care. The objective of our study was to analyze the temporal distribution of trauma-related deaths, the factors that characterize that distribution and how those factors have changed over time at our urban level 1 trauma center...
November 3, 2016: Injury
https://www.readbyqxmd.com/read/27846034/an-update-on-classification-and-management-of-urosepsis
#11
Florian M E Wagenlehner, Zafer Tandogdu, Truls E Bjerklund Johansen
PURPOSE OF REVIEW: The urinary tract is the infection site in severe sepsis/septic shock in 10-30%. RECENT FINDINGS: There is a new Sepsis definition focusing on severe sepsis. Urosepsis is mainly due to obstructed uropathy of the upper urinary tract. The pathogenesis of sepsis is complex and is driven by the innate immune system. In the further course immunosuppression is developing.Management of urosepsis includes early diagnosis, early initiation of treatment such as identification and control of the complicating factor in the urinary tract and the specific sepsis therapy...
November 14, 2016: Current Opinion in Urology
https://www.readbyqxmd.com/read/27837163/sepsis-and-shock-response-team-impact-of-a-multidisciplinary-approach-to-implementing-surviving-sepsis-campaign-guidelines-and-surviving-the-process
#12
Ami Grek, Sandra Booth, Emir Festic, Michael Maniaci, Ehsan Shirazi, Kristine Thompson, Angela Starbuck, Chad Mcree, James M Naessens, Pablo Moreno Franco
The Surviving Sepsis Campaign guidelines are designed to decrease mortality through consistent application of a 7-element bundle. This study evaluated the impact of improvement in bundle adherence using a time-series analysis of compliance with the bundle elements before and after interventions intended to improve the process, while also looking at hospital mortality. This article describes interventions used to improve bundle compliance and hospital mortality in patients admitted through the emergency department with sepsis, severe sepsis, or septic shock...
November 10, 2016: American Journal of Medical Quality: the Official Journal of the American College of Medical Quality
https://www.readbyqxmd.com/read/27752318/a-collaborative-improvement-project-by-an-nhs-emergency-department-and-scottish-ambulance-paramedics-to-improve-the-identification-and-delivery-of-sepsis-6
#13
Martin Carberry, John Harden
Early identification of patients with sepsis is key to the delivery of the sepsis 6 bundle including antibiotic therapy within an hour.[1-3] Demand versus capacity challenges in the Emergency Department (ED) led to delays in antibiotic and sepsis 6 delivery. An alerting tool was developed that provided criteria for Scottish Ambulance Service (SAS) Paramedics to alert the ED of potential sepsis patients. Data from patients presenting to the ED prior to the alerting process commencing (n=50) and during alerting (n=50) were analysed, a questionnaire was used to ascertain feedback from all staff groups; nurses doctors, and paramedics (n=38)...
2016: BMJ Quality Improvement Reports
https://www.readbyqxmd.com/read/27752314/making-the-journey-safe-recognising-and-responding-to-severe-sepsis-in-accident-and-emergency
#14
Sarah Pinnington, Brigid Atterton, Sarah Ingleby
Severe sepsis is a clinical emergency. Despite the nationwide recognition of the sepsis six treatment bundle as the first line emergency treatment for this presentation, compliance in sepsis six provision remains inadequately low. The project goals were to improve compliance with the implementation of the Sepsis Six in patients with severe sepsis and/or septic shock. In improving timely care delivery it was anticipated improvements would be made in relation to patient safety and experience, and reductions in length of stay (LoS) and mortality...
2016: BMJ Quality Improvement Reports
https://www.readbyqxmd.com/read/27749512/2016-update-for-the-rogers-textbook-of-pediatric-intensive-care-recognition-and-initial-management-of-shock
#15
Julie C Fitzgerald, Scott L Weiss, Niranjan Kissoon
OBJECTIVE: To review important articles in the field of pediatric shock and pediatric septic shock published subsequent to the Fifth Edition of the Rogers' Textbook of Pediatric Intensive Care. DATA SOURCES: The U.S. National Library of Medicine PubMed (www.ncbi.nlm.nih.gov/pubmed) was searched for combination of the term "pediatric" and the following terms: "sepsis, septic shock, shock, antibiotics, extracorporeal membrane oxygenation, and steroid." The abstract lists generated by these searches were screened for potential inclusion...
November 2016: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/27720289/new-mandated-centers-for-medicare-and-medicaid-services-requirements-for-sepsis-reporting-caution-from-the-field
#16
Emily L Aaronson, Michael R Filbin, David F M Brown, Kathy Tobin, Elizabeth A Mort
BACKGROUND: The release of the Center for Medicare and Medicaid Service's (CMS) latest quality measure, Severe Sepsis/Septic Shock Early Management Bundle (SEP-1), has intensified the long-standing debate over optimal care for severe sepsis and septic shock. Although the last decade of research has demonstrated the importance of comprehensive bundled care in conjunction with compliance mechanisms to reduce patient mortality, it is not clear that SEP-1 achieves this aim. The heterogeneous and often cryptic presentation of severe sepsis and septic shock, along with the multifaceted criteria for the definition of this clinical syndrome, pose a particular challenge for fitting requirements to this disease, and implementation could have unintended consequences...
October 5, 2016: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27713890/implementing-sepsis-bundles
#17
Mathieu Jozwiak, Xavier Monnet, Jean-Louis Teboul
Sepsis bundles represent key elements of care regarding the diagnosis and treatment of patients with septic shock and allow ones to convert complex guidelines into meaningful changes in behavior. Sepsis bundles endorsed the early goal-directed therapy (EGDT) and their implementation resulted in an improved outcome of septic shock patients. They induced more consistent and timely application of evidence-based care and reduced practice variability. These benefits mainly depend on the compliance with sepsis bundles, highlighting the importance of dedicated performance improvement initiatives, such as multifaceted educational programs...
September 2016: Annals of Translational Medicine
https://www.readbyqxmd.com/read/27661863/quality-improvement-initiative-for-severe-sepsis-and-septic-shock-reduces-90-day-mortality-a-7-5-year-observational-study
#18
Christian S Scheer, Christian Fuchs, Sven-Olaf Kuhn, Marcus Vollmer, Sebastian Rehberg, Sigrun Friesecke, Peter Abel, Veronika Balau, Christoph Bandt, Konrad Meissner, Klaus Hahnenkamp, Matthias Gründling
OBJECTIVE: To investigate the impact of a quality improvement initiative for severe sepsis and septic shock focused on the resuscitation bundle on 90-day mortality. Furthermore, effects on compliance rates for antiinfective therapy within the recommended 1-hour interval are evaluated. DESIGN: Prospective observational before-after cohort study. SETTING: Tertiary university hospital in Germany. PATIENTS: All adult medical and surgical ICU patients with severe sepsis and septic shock...
September 22, 2016: Critical Care Medicine
https://www.readbyqxmd.com/read/27659434/mortality-risk-factors-for-patients-with-septic-shock-after-implementation-of-the-surviving-sepsis-campaign-bundles
#19
Je Eun Song, Moo Hyun Kim, Woo Yong Jeong, In Young Jung, Dong Hyun Oh, Yong Chan Kim, Eun Jin Kim, Su Jin Jeong, Nam Su Ku, June Myung Kim, Jun Yong Choi
BACKGROUND: Septic shock remains a leading cause of death, despite advances in critical care management. The Surviving Sepsis Campaign (SSC) has reduced morbidity and mortality. This study evaluated risk factors for mortality in patients with septic shock who received treatment following the SSC bundles. MATERIALS AND METHODS: This retrospective cohort study included patients with septic shock who received treatments following SSC bundles in an urban emergency department between November 2007 and November 2011...
September 2016: Infection & Chemotherapy
https://www.readbyqxmd.com/read/27632674/sepsis-pathophysiology-chronic-critical-illness-and-persistent-inflammation-immunosuppression-and-catabolism-syndrome
#20
Juan C Mira, Lori F Gentile, Brittany J Mathias, Philip A Efron, Scott C Brakenridge, Alicia M Mohr, Frederick A Moore, Lyle L Moldawer
OBJECTIVES: To provide an appraisal of the evolving paradigms in the pathophysiology of sepsis and propose the evolution of a new phenotype of critically ill patients, its potential underlying mechanism, and its implications for the future of sepsis management and research. DESIGN: Literature search using PubMed, MEDLINE, EMBASE, and Google Scholar. MEASUREMENTS AND MAIN RESULTS: Sepsis remains one of the most debilitating and expensive illnesses, and its prevalence is not declining...
September 14, 2016: Critical Care Medicine
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