NURS11158 - Safety and Quality Health Service Standards (NSQHS) - Nursing Assignment Help

Assignment Task

Summary of Evidence and Recommendations
With an increasing number of patients presenting to the Emergency Department (ED) with suspected sepsis, an overview of the evidence available and how this relates to the National Safety and Quality Health Service Standards (NSQHS) is explored. Sungkar, Considine, and Hutchinson (2018) found that for each hour that antibiotics are not administered, the mortality rate in sepsis patients increases.Weiss et al. (2014) also outline the increasing risk of mortality in paediatric patients with every hour antimicrobial therapy is delayed, although they dosuggest thatnegative implications were not seen until after three hours .The Surviving Sepsis Campaign (SSC) has developed clinical practice guidelines and bundlesthat outline a comprehensive, evidence-based approach to the screening and management of sepsis patients(SSC, n.d.).  Some of the key recommendations in these guidelines include initial intravenous (IV) fluid resuscitation, blood collection, lactate measurement, the commencement of vasopressors (if required)and antibiotic administration within the first hour of sepsis recognition (Rhodes et al., 2017).  Implementing these guidelines supports the NSQHS Standards 1.27 and 5.10 by ensuring that systems are in place tosupport the use of evidence-based care and also thaton-presentationpatients are screened for sepsis risk (Australian Commission of Safety and Quality in Health Care [ACSQHC], 2017a, 2017c) .These Standards are also addressed by the Clinical Excellence Commission (2014) in their evidence-based program Sepsis Kills, which focuses on the three R’s: recognising sepsis, resuscitating with IV fluid and antibiotics in the first hour, and referral of patient as needed.  While Weiss et al. (2014) did not fully support the SSC’s recommendation of administering antimicrobial therapy within the first hour of recognition of sepsis, they did advise to avoid delays of longer than three hours due to the increased risk of mortality and complications.However, Johnston et al. (2017)analysed the data collected and suggests thatantimicrobial therapy commenced in the first hour is linked with a reduction of up to 33% in the mortality rate of sepsis patients . These results support the NSQHS Standard 8.10 for the initiation of rapid sepsis management after identifying acute deterioration in the patient (ACSQHC, 2017d) .Zhang, Micek, and Kollef (2015) outline that delaying an appropriate antimicrobial regime was not only linked to higher mortality rates, but also increased intensive care unit andhospital lengths of stay. Due to the increasing incidence of antibiotic resistance in infections that can cause sepsis, ineffective antimicrobial therapy is being administered more frequently (Zhang et al., 2015).  The NSQHS Standard 3.16 highlights a system that focuses on the safe and appropriate prescribing and monitoring of antibiotics (ACSQHC, 2017b) . Directly relating to this standard, Zhang et al. (2015) agree that the need for timely and targeted, rather than broad-spectrum, antimicrobial therapy is of continued importance in the effective management of sepsis . This is also supported by Agenda 12.2 (Seventieth World Assembly, 2017), which acknowledges that excessive antibiotic use can lead to antibiotic resistance, and also recognises that the appropriate and early use of antimicrobials is a key factor in sepsis treatment. The evidence that has beenappraised regarding the timing of antibiotic administration also has multiple ethical considerations to explore in nursing practice.
Ethical Considerations 
Four ethical principles need to be considered when reviewing the current nursing practice in this facility: autonomy, beneficence, non-maleficence, and justice. At present, the facility has no policies in place regarding the treatment and timing of antibiotic administration in patients presenting with sepsis, meaning that each patient is receiving different treatments with varying outcomes. This current practice is not considered to be fair as itconflicts with the ethical principle of justice by failing to have a pathway in place that guarantees equity in guidingclinical decision making and recommendations in the management of all septic patients(Grace & Kirkpatrick, 2018).Weiss et al. (2014) support this,pointing out that patients being treated using a clinical pathway for recognition and management of sepsis received antibiotics earlier than those whose treatment did not follow this pathway. Additionally, introducing clinical guidelines adheres to autonomy, described by Grace and Kirkpatrick (2018), as a patient being aware of the process that will take place in their treatment which allows them (or a parent/caregiver) to provide informed consentin the management of their condition. When considering non-maleficence, it could be argued that due to the increasing incidence of antibiotic resistance, administering broad-spectrum antibiotics without a known pathogen goes against this principle as it has the potential to do harm (Staunton & Chiarella, 2017). In contrast, withholding antibiotics due to the risk of antibiotic resistance could be potentially deadly when considering sepsis cases;thus, timely administration of antimicrobial therapy is demonstrated to inflict the least harm possible (Seventieth World Assembly, 2017). Sherwin, Winters, Vilke, and Wardi (2017) concluded that more patients were found to benefit from rapid antibiotic therapy than those who do not, which agrees with Staunton & Chiarella’s (2017) explanation of beneficence; acting in the best interests of the patient and doing good. With these ethical principles considered, it is highly recommended that this facility incorporates sepsis management policies using evidence-based practice.
Suggestions for Facility to Incorporate Evidence-based Nursing Practice
After researching and summarising a widerange of evidence and exploring the ethical considerations associated with the current and future practice of this facility, four suggestions will be presented. The diagnosis, implementation of bundles of care, staff education and reviewing of the implementation of these guidelines, will aid the incorporation of current evidence into future policies and clinical nursing practice for the facility.Sungkar et al. (2018) emphasise that the inability to accurately identify sepsis and apply guidelines into clinical practice within the ED are both barriers to timely antimicrobial administration.Firstly, the introduction of diagnostic criteria to assist with the identification of sepsis patientsand an automated alert once specified diagnostic criteria are triggered, would be beneficial in detecting possible sepsis cases(Sungkar et al., 2018). The second recommendation is the implementation of a bundle of care which was demonstrated by Sungkar et al. (2018) to positivelyaffect the timing of antibiotics given. The SSC (n.d.) Hour-1 Bundle offers an effective treatment pathway in the management of sepsis. Thirdly, staff education was a key factor in initiating guidelines and could be addressed through printed and electronic resources, and educational meetings (Sungkar et al., 2018). Lastly, Sungkar et al. (2018) recognises that audit and review processes are vital in monitoring the effectiveness and adherence to guidelines. Implementing sepsis management guidelines in the EDproves to be crucial in improving the timing of antibiotic administration and thus patient outcomes.
 

This NURS11158 Nursing Assignment has been solved by our Nursing Experts at My Uni Paper. Our Assignment Writing Experts are efficient to provide a fresh solution to this question. We are serving more than 10000+ Students in Australia, UK & US by helping them to score HD in their academics. Our Experts are well trained to follow all marking rubrics & referencing style.

Be it a used or new solution, the quality of the work submitted by our assignment experts remains unhampered. You may continue to expect the same or even better quality with the used and new assignment solution files respectively. There’s one thing to be noticed that you could choose one between the two and acquire an HD either way. You could choose a new assignment solution file to get yourself an exclusive, plagiarism (with free Turnitin file), expert quality assignment or order an old solution file that was considered worthy of the highest distinction.