Sepsis is a formidable complication of cancer and cancer treatment. Claiming more than 250,000 lives annually, it is a medical emergency. Do you have sepsis algorithms and protocols in place? Do all specialty areas have a way to identify patients with cancer as a highly vulnerable population? Is sepsis-specific education provided to nurses and patients? Starting the conversation and advocating for policy development and change may just save a life.
Resources to Facilitate Conversation
The Centers for Disease Control and Prevention (CDC) launched a Get Ahead of Sepsis campaign and toolkit for patients, caregivers, and all healthcare professionals to be able to recognize sepsis and intervene quickly at first suspicion. Resources target not only nurses and healthcare professionals in all care settings and specialty areas but patients and caregivers as well. This is such an important inclusion, because educating patients with cancer about the signs and symptoms of infection and empowering them to advocate for early intervention are crucial to optimal outcomes.
Infographics are proving to be a valuable tool in patient and healthcare professional education. Printable infographics highlighting signs and symptoms and early intervention strategies are available for sharing in your unit or practice site and for use in your patient education. During patient education, nurses must highlight factors unique to patients with cancer. For example, they may have a lower threshold for fever, which is a common sign of infection. Also, consider discussing other risk factors that make them susceptible and teach them what to look for if they develop symptoms while at home. For your hospitalized patients, daily audits of indications for indwelling catheters and central lines have shown to be an effective method to decrease catheter and central line days, thereby reducing risk of infection and sepsis.
Oncology nurses need to know the signs and clinical presentation. The CDC resources remind us that signs requiring immediate action are confusion or disorientation, shortness of breath, tachycardia, fever, extreme pain or discomfort, and clammy skin. However, we know some of these may not be the earliest of indications and may indicate that organ perfusion is already compromised. Furthermore, some of these may be masked in immunocompromised patients. Any slight change in assessment findings in neutropenic patients could mean impending sepsis and warrants communication with the interprofessional team.
What can be so challenging in early sepsis intervention in the oncology population is when patients with sepsis symptoms present to other units or receiving areas, such as an emergency room or primary care office. Many oncology practices and nurses have developed procedures to identify patients who are neutropenic and therefore further susceptible to sepsis and poor outcomes that can be used by providers and clinicians in other specialty areas to signify a higher risk of sepsis and a lower threshold to initiate sepsis protocols should be employed.