Objectives: To provide a series of recommendations based on the best available evidence to guide clinicians providing nursing care to patients with severe sepsis.
Design: Modified Delphi method involving international experts and key individuals in subgroup work and electronic-based discussion among the entire group to achieve consensus.
Methods: We used the Surviving Sepsis Campaign guidelines as a framework to inform the structure and content of these guidelines. We used the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) system to rate the quality of evidence from high (A) to very low (D) and to determine the strength of recommendations, with grade 1 indicating clear benefit in the septic population and grade 2 indicating less confidence in the benefits in the septic population. In areas without complete agreement between all authors, a process of electronic discussion of all evidence was undertaken until consensus was reached. This process was conducted independently of any funding.
Results: Sixty-three recommendations relating to the nursing care of severe sepsis patients are made. Prevention recommendations relate to education, accountability, surveillance of nosocomial infections, hand hygiene, and prevention of respiratory, central line-related, surgical site, and urinary tract infections, whereas infection management recommendations related to both control of the infection source and transmission-based precautions. Recommendations related to initial resuscitation include improved recognition of the deteriorating patient, diagnosis of severe sepsis, seeking further assistance, and initiating early resuscitation measures. Important elements of hemodynamic support relate to improving both tissue oxygenation and macrocirculation. Recommendations related to supportive nursing care incorporate aspects of nutrition, mouth and eye care, and pressure ulcer prevention and management. Pediatric recommendations relate to the use of antibiotics, steroids, vasopressors and inotropes, fluid resuscitation, sedation and analgesia, and the role of therapeutic end points.
Conclusion: Consensus was reached regarding many aspects of nursing care of the severe sepsis patient. Despite this, there is an urgent need for further evidence to better inform this area of critical care.
From the Research Centre for Clinical and Community Practice Innovation (LMA), Griffith University, Nathan, Queensland, Australia; Intensive Care Unit (LMA), Princess Alexandra Hospital, Woolloongabba, Queensland, Australia; Gold Coast Health Services District (GW), Gold Coast, Queensland; Research Centre for Clinical and Community Practice Innovation (GW), Griffith University, Gold Coast, Queensland, Australia; Consultants in Critical Care (MH), Glenbrook, NV; General Internal Medicine and Infectious Diseases (SB), Ghent University Hospital, Ghent, Belgium; Faculty of Medicine and Health Sciences (SB, SL), University Ghent, Ghent, Belgium; Faculty of Healthcare (SB, SL), University College Ghent, Ghent, Belgium: Center for Clinical Research & Scholarship (RK), Rush University Medical Center, Chicago, IL; Faculty of Nursing and Midwifery (AM), University of Sydney, NSW, Australia; Nursing Practice Development Unit (GRB), Princess Alexandra Hospital, Woolloongabba, Queensland, Australia; Children's Services (PMH), Sinai Hospital of Baltimore, Baltimore, MD; Patient Safety Programme (WR), Nottingham University Hospitals, UK; Advocate BroMenn Medical Center (APJ), Normal, IL; KK Women's and Children's Hospital (PNL), Singapore; and Barnes-Jewish Hospital (TA), St. Louis, MO.
This project was conducted under the auspices of the World Federation of Critical Care Nurses (WFCCN), and no sponsorship or funding was received for this project.
Dr. Blot received honoraria/speaking fees from Covidien and Cook Critical Care. The remaining authors have not disclosed any potential conflicts of interest.
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