New sepsis guidelines

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• The term severe sepsis is redundant.

• Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection.

• The clinical criterion for organ dysfunction is an increase in the SOFA (Sequential Organ Failure Assessment) score of 2 or more points, which has an associated in-hospital mortality exceeding 10%.

• Septic shock is a subset of sepsis with greater mortality risk than with sepsis alone because of particularly severe circulatory, cellular, and metabolic abnormalities.

• Clinical criteria for septic shock are the need for a vasopressor to maintain mean arterial pressure of 65 mm Hg or greater and a serum lactate level of more than 2 mmol/L (>18 mg/dL) in the absence of hypovolemia. • The combination of these 2 criteria predicts hospital mortality rates exceeding 40%.

• The task force defined a new bedside clinical score termed quick SOFA (qSOFA).

• The qSOFA score is used to assess just 3 symptoms in patients with suspected sepsis: altered mental status, fast respiratory rate and low blood pressure. Blood tests are not required. If patients with infection show two of the three criteria, they should be considered likely to be septic.

• Adult patients with suspected infection in out-of-hospital, emergency department, or general hospital ward settings are more likely to have poor outcomes typical of sepsis if they have more than 2 qSOFA clinical criteria: respiratory rate of 22 breaths per minute or higher, altered mental status and/or systolic BP of 100 mm Hg or less.

• qSOFA was a better predictor of hospital mortality for patients with suspected infection who were not in the ICU than for those in the ICU. (Source: JAMA, February 23 issue)

Establishing Roles & Responsibilities for Interprofessional Care Team Members

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General Competency Statement: Use the knowledge of one’s own role and the roles of other professions to appropriately assess and address the healthcare needs of the patients and populations served.

Specific Roles/Responsibilities Competencies
RR1. Communicate one’s roles and responsibilities clearly to patients, families, and other professionals.
RR2. Recognize one’s limitations in skills, knowledge, and abilities.
RR3. Engage diverse healthcare professionals who complement one’s own professional expertise, as well as associated resources, to develop strategies to meet specific patient care needs.
RR4. Explain the roles and responsibilities of other care providers and how the team works together to provide care.
RR5. Use the full scope of knowledge, skills, and abilities of available health professionals and healthcare workers to provide care that is safe, timely, efficient, effective, and equitable.

Values and Ethics of Interprofessional Collaboration

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Work with individuals of other professions to maintain a climate of mutual respect and shared values.
Specific competencies
  • VE1. Place the interests of patients and populations at the center of interprofessional healthcare delivery.
  • VE2. Respect the dignity and privacy of patients while maintaining confidentiality in the delivery of team-based care.
  • VE3. Embrace the cultural diversity and individual differences that characterize patients, populations, and the healthcare team.
  • VE4. Respect the unique cultures, values, roles/responsibilities, and expertise of other health professions.
  • VE5. Work in cooperation with those who receive care, those who provide care, and others who contribute to or support the delivery of prevention and health services.
  • VE6. Develop a trusting relationship with patients, families, and other team members.
  • VE7. Demonstrate high standards of ethical conduct and quality of care in one’s contributions to team-based care.
  • VE8. Manage ethical dilemmas specific to interprofessional patient-/population-centered care situations.
  • VE9. Act with honesty and integrity in relationships with patients, families, and other team members.
  • VE10. Maintain competence in one’s own profession appropriate to scope of practice
(Source: Interprofessional Education Collaborative (IPEC) Core Competencies)

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