Engagement is the key to success for 'Code Sepsis'

Mon, 01/20/2014 - 15:14

The 5th National Meeting of the Perioperative Infections Working Group(Gtipo)of the Spanish Society ofAnesthesiology, Resuscitation and Pain Treatment (Sedar), held in Valencia last weekend focused on an update on management of critical patients with sepsis and multiple organ dysfunction. At this event, coordinated by Gerardo Aguilar and Juan Carlos Valía, anesthesiologists of the Clinical and the General Hospitals of Valencia, respectively, specialists discussed the positive impact of the Spanish Code Sepsis (see DM of 24-11-2010), in particular the level of engagement of professionals.

The objective of the CodeSepsisis earlydetectionof patients with severesepsis(at the various care levels),the structuredapplicationof a set of recommended measures to diagnose, monitor and treat patients, and the definition of care indicators to evaluate compliance with recommendations and results of implementing the code locally and nationwide.

Marcio Borges, coordinator of the Multidisciplinary Sepsis Unit, in the Intensive Medicine Service at the Hospital Son Llàtzer (Palma) and national coordinator of the Code Sepsis, explained to DIARIO MÉDICO that "a year ago, the Palma de Mallorca Declaration was signed, in which thirteen societies expressed the need for change and that the best way was by joining efforts and generating a series of coordinated actions".

Now "twenty-one Spanish scientific societies have joined us plus nine international ones, as well as having the support and collaboration of the Ministry of Health and its Quality Area”. Thanks to this encouragement and dividing the project into various actions, very significant initiatives have been achieved. For example, he mentioned the drafting of a consensus document on early management of sepsis which, in a few weeks, “following its final review, will be sent for publication to the main journals of the scientific societies involved”.


In addition, a web platform has been developed and is about to be launched, to include activities such as forums, online symposia, information and links to the societies, expert reviews, studies, etc. Likewise, a training course on sepsis has been prepared, "initially to be presented to regional representatives and coordinators and subsequently, to be disseminated at hospitals", without forgetting to conduct surveys and studies "to assess the impact of implementing the code in hospitals based on specific quality indicators".

With regard to the results obtained so far, Borges highlighted the "engagement of healthcare professionals and their respective scientific societies. We are in the process of consolidating the project and have started measuring the current situation, as there is very little information considering all of the hospital settings”. The key is awareness that this is a public health problem related to patient safety and that organizational changes are needed to improve its management, which must be comprehensive, multidisciplinary and bring together all healthcare actors”.


"Undoubtedly, improvement lies in implementing a practical educational process and generating cross-functional working groups in the hospitals with the maximum participation possible of physicians and nurses”. To this effect, “we have divided the models into four possibilities, depending on hospital characteristics and existing structures: committees, groups, rapid intervention teams and sepsis multidisciplinary functional units”. According to Borges, "this is a continuous process in time, interacting with all hospital areas, with different types of patients and involving all healthcare professionals. This is why it so enormously difficult to maintain as an activity of daily care, but also of education and research".

Moreover, he admits that "any change in healthcare is very complex, even more so when it involvesso many professionals from different areas and specialities, but generating a realistic and practical educational process, and having information on the results of these changes, is the way to encourage healthcare professionals to establish and apply them."

Nursing,essential for diagnosis and treatment

Nursing plays a very important role in the Sepsis Multidisciplinary Units,as stated by Clara Hurtado, from the Sepsis Multidisciplinary Unit of the University Hospital Doctor Peset of Valencia. "The care provided by nurses is essential to reduce the time for diagnosis and treatment of severe sepsis and septic shock, as well as providing care for patient safety and evidence-based practice".

At the units "it provides a comprehensive vision of patient care and brings together all other professionals improving communications among them and with the rest of the hospital".

Nurses perform educational tasks in the hospital aimed at professionals and patients to improve the care of septic patients and reduce infections associated to healthcare. Hurtado says that "in the short and medium-term, nursing is capable of taking on the leadership to design and implement new sepsis cross-functional units, train professionals and set up strategies to incorporate evidence to practice".

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