Antibiotics Before Cultures in Septic Suspected Patients

Antibiotics Before Cultures in Septic Suspected Patients No More Waiting Antibiotics Before Cultures in Septic Suspected Patients Shannin Pierce Introduction Identifying the Issue September, 21 2013 was an abnormally busy day at Northeast Clark Hospital. At 6:45 AM, 63 year old Mr. Davis Jones, present to the emergency department with a fever of 102.6, heart rate of 110 beats per minute, and a respiratory rate of 22. His blood pressure is 91/63. He is weak and lethargic. His wife tells staff that during the past week he has been sleeping more than usual and not eating or drinking much. She suspects he has come down with the flu that has been going around. Mr. Jones is sent to a room and asked to put on a gown and informed that the doctor will be right in to see him. At 7:00, the night shift nurse reports off the dayshift nurse of all of her patients, but fails to inform the dayshift nurse that Mr. Jones has yet to have cultures collected. At 7:15, the dayshift nurse checks on Mr. Jones who is comfortably sleeping in the hospital bed with his wife by his side. Vital have not changed since admission. She continues to the next patient. At 7:30 AM she rechecks on Mr. Jones and realizes that he has yet to have cultures drawn and collects the supplies. Cultures are collected at 7:45 AM and sent to the lab. At 8:00 lab results show WBC 16,000. The nurse reports the findings immediately to the attending physician, who orders intravenous (IV) antibiotics and fluids. Pharmacy sends up the antibiotics at 8:30 AM and the nurse begins infusion at 8:45 AM. At 9:00 AM, Mr. Joness blood pressure drops to 58/42, heart rate soars to 160 beats per minute, and he is unconscious and unresponsive. The staff frantically rushes to infuse IV fluid into Mr. Jones but he goes into cardiac arrest. All resuscitation attempts are made, but at 9:45, Mr. Jones is pronounced dead. Sepsis and bloodstream infections have become a major cause of hospitalization and death in the United States. In these situations it is a standard protocol to collect blood cultures before administration of antibiotic, however, this can often delay the treatment needed to reduce the chance of death of patients with septicemia. With new advances in culture collection technology, blood culture collection containers now contain antimicrobial removal media, which makes it no longer necessary to delay treatment of antibiotics in order to wait for untreated blood specimens to be collected. By using the antimicrobial removal media enriched blood collection containers for all patients with suspected sepsis, antibiotic treatment can be initiated faster, hospital stays will be shorter, cost of care will be decreased, and fewer people will die due to septicemia. Analysis of the Current Situation Currently, standard protocol for septic suspected patients is for blood cultures to be collected from two different ventipuncture sites before the initiation of any antibiotic therapy using aseptic technique. It is also recommended that antibiotic therapy be initiated within one hour of onset of septicemia. According to a research study by Anand Kumar (2006), every hour of delay in antimicrobial therapy result in an increase in mortality of 7.6%. While the majority of hospital facilities strive to achieve the goal of cultures and antimicrobial therapy within the one hour time frame, the reality is that very few are actually successful. It is estimated that only about 12% of patients actually receive the antimicrobial therapy within the first hour (Daniels, 2011). To make matters worse, emergency departments struggle with overcrowding. According to hospitalstats.org, the median emergency department wait time in the Clark County Valley is 3 hours 25 minutes (Hospital Stats, 2014). Identifying the signs and symptoms of sepsis is a huge barrier to providing timely treatment. Another huge problem with the standard protocol for cultures before antibiotic therapy is that 50% to 82% of patients presenting to the emergency or intensive care facilities with suspected septicemia have already been given an antibiotic before admission and culture collection (Zadroga et al., 2013). However, with the initiation of facilities using antimicrobial removal resin blood culture containers, such as BACTEC PLUS, many of the barriers to providing timely care to septic suspected patients can be overcome. BACTEC PLUS has been proven to recover 95.1% of bacterial pathogens in blood culture samples with therapeutic levels of antimicrobial agents present, and 100% of strains in control bottles (Flayhart, Borek, Wakefield, Dick, Carroll, 2007). Leading Change It is estimated that 20,000 people die worldwide every day from sepsis (Daniels, 2011). While the use of blood culture analysis is and always will be one of the most important evidence-based microbial testing procedures for determining diagnosis of septicemia, the need to wait for cultures to be drawn before administering life saving antimicrobial therapy is unnecessary. Patients with suspected septicemia need to be receiving antimicrobial therapy within the one hour time frame, whether or not cultures have been drawn. It needs to become standard protocol that the antimicrobial therapy be initiated in that one hour time frame, and move away from the standard being cultures first. To initiate this change, it is proposed that implementation of antimicrobial therapy be initiated immediately in septic suspected patients. The Process of Change Change will being in the emergency department. All medical staff, including physicians, nurses, LPNs, CNAs, and technicians will be informed of the change to take place by having multiple conferences and training sessions over a period of time, no less than four weeks, with a minimum of three different time slots occurring near shift change to accommodate all shifts for all employees to be able to attend. All attending staff will sign an agreement contract, including the understanding of the new policy to be implemented. Once they have been fully informed and have had the opportunity to express all misunderstanding and concerns with the new policy, implementation of the policy in the department will ensue. The emergency department will be fully stocked with BACTEC blood collection containers. Quality control agents will monitor compliance of the policy to record all valid data associated, including time frames of initiation of the antimicrobial agent and blood culture analysis using the antimicrobial removal media. Most importantly, infection control will assess the outcome of patients with confirmed septicemia and will closely evaluate the new treatment plan to verify if the policy is proving to be helpful in improving the outcome of patient survival rates. Impact of Change If outcomes are positive, the facility can being to implement the policy, following the same steps already stated, to more departments and continue to evaluate the effectiveness of the policy on each department until the entire facility is using the policy. In order to initiate the change it will take a team effort. All staff will need to comply in ensuring that all septic patients are receiving the antimicrobial therapy within the one hour time frame, regardless if cultures have been drawn first or not. This will be imperative for analysis as to if the new policy is effective in reducing the mortality rate of septic patients. Conclusion Sepsis infections are going to continue to be a major cause of hospitalization, but with new protocols including ensuring administration of antibiotics in septic suspected patients within the one hour time frame of onset regardless if cultures have been collected first, we can reduce the chance of death for these patients. As medical staff, we need to use the advances in culture collection containers like BACTEC to initiate faster treatment, which will make hospital stays shorter, decrease cost of care, and most importantly, save more lives. References Daniels, R. (2011). Surviving the first hours in sepsis: getting the basics right an intensivist’s perspective. Journal of Antimicrobial Chemotherapy, 66(2), ii11-ii23. Retrieved from http://jac.oxfordjournals.org/content/66/suppl_2/ii11.full#ref-36 Flayhart, D., Borek, A., Wakefield, T., Dick, J., Carroll, K. (2007). Comparison of BACTEC PLUS blood culture media to BacT/Alert FA blood culture media for detection of bacterial pathogens in samples containing therapeutic levels of antibiotics. Journal of Clinical Micrbiology, 45(3), 816-821. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1829095/?report=reader Hospital Stats (2014). ER wait times in Clark County hospitals. hospitalstats.org. Retrieved from http://www.hospitalstats.org/ER-Wait-Time/Clark-County-NV.htm Kumar, A., Roberts, D., Wood, K., Light, B., Parrillo, J., Sharma, S. (2006, June). Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Critical Care Medicine, 34(6), 1589-1596. Retrieved from http://cel.webofknowledge.com/InboundService.do?product=CELSID=2DqQrrN9uYLqpUXhgpgUT=000237884300001SrcApp=Highwireaction=retrieveInit=YesSrcAuth=HighwirecustomersID=HighwireFunc=FrameIsProductCode=Yesmode=FullRecord Uzodimma, C., Njokanma, F., Ojo, O., Falase, M., Ojo, T. (2013, ). Bacterial isolates from blood cultures of children with suspected sepsis in an urban hospital in Lagos: a prospective study using BACTEC blood culture system. The Internet Journal of Pediatrics and Neonatology, 16(1). Retrieved from http://ispub.com/IJPN/16/1/1623 Zadroga, R., Williams, D., Gottschall, R., Hanson, K., Norberg, V., Deike, M., Hansen, G. (2013). Comparison of 2 blood culture media shows significant differences in bacterial recovery for patients on antimicrobial therapy. Oxford Journals Clinical Infectious Diseases, 56(6), 790-797. Retrieved from http://cid.oxfordjournals.org/content/56/6/790.full

Neat vs Sloppy

The Eternal Debate between the Neat and Sloppy Neat People vs.. Sloppy People by Suzanne Bruit takes a unique stance on clutter. The author believes a person preference on their cleanliness is boiled down to a moral standpoint. Sloppy people are not sloppy, they only have a precise plan that will never co me to fruition. She views neat people as wasteful, lazy, and ungrateful. This stance is unique and interesting but without data it is simply speculation. The author seems to be biased.She says sloppy people â€Å"give loving attention to every diet ail†(256). As a sloppy person myself I reject this. Yes, I sometimes have trouble judging the I importance of a piece of paper and keep it. Most of the time I stash useless papers because the ere simply is no trash can near me. Furthermore, she believes neat people are self centered and mindless as pop used to mindful. â€Å"If anything collects dust, it's got to go† (256). My mother is the clean SST person I know. He is als o very concerned about the environment.She recycles and ere sees furniture until it breaks. She has three dogs and each of them are clean. She just prefers clean lines and cleanliness provides a more positive environment than a Sloppy one. While I enjoyed reading the story, it seemed whiny and biased. I feel bad for S Suzanne for not knowing decent clean people. If she had ever seen the show hoarders she would know that not all sloppy people are morally superior. If she had evidence, this could have e been a great paper.

Psychology and Biology Essay

The essay will begin with an introduction to each approach, giving main assumptions and supporting evidence. Following this, the two theories will be compared and contrasted, looking at strengths and weaknesses. In conclusion there will be a short explanation of the main areas of similarity, and differences  Psychology and its many definitions has changed radically and frequently over time, as an independent area of study. There are many different theoretical views, some conflicting, regarding the most appropriate methods for investigating human nature. The approaches chosen to discuss in this essay are biology psychology and comparative psychology. Biopsychology is the scientific study of the biology of behaviour.Some refer to this field as psychobiology,behavioural biology,behavioural neuroscience.It is an integrative discipline. The study of the biology of behaviour has a long history,but biopsychology did not coalesce into a major neuroscientific discipline until this century.Biopsychologists draw together knowledge from the other neuroscientific disciplines and apply it to the study of behaviour. Biopsychologists are neuroscientists who brings to their research a knowledge of behaviour and the methods of behavioural research. They uses animals because their methods of study can not be used with humans. Comparative psychology is the branch of psychology concerned with the study of animal behaviour. Modern research on animal behaviour began with the work of Charles Darwin and Georges Romanes and has continued to grow into a multidisciplinary subject. Today, biologists, psychologists, anthropologists, ecologists, geneticists and many others contribute to the study of animal behaviour.Comparative psychologists compare the behaviour of different species and focus on the genetics,evolution and adaptivness of behaviour.Historically,comparative psychologists have focused on the experimental investigation of animal behaviour in controlled laboratory environments.Modern comparative psychology also encompasses the study of animal behaviour in its natural environment. For Biopsychology,biological bases have been found for a range of psychological disorders. Schizophrenics, for example, have been found to have different brain structures to other people, with smaller brains and higher-than-normal levels of dopamine.Looking at the chemical make-up of the brain has lead to the successful production of a range of drug treatments in recent decades that have helped in the treatment of a variety of issues, including Prozac (for depression), schizophrenia. However,The biological approach in psychology is highly reductionist in its approach to the complexity of human behavior and emotion. Reducing our feelings and reactions to robot-like behavior is not only unethical, it also ignores the factors in our every day environment – our childhood experiences and the influence and behavior of friends and media – that have been found to affect us.Many drug treatments have unwanted side-effects. Claims, for example, that Prozac can cause violent behavior after taking it, are not uncommon, so the claim that the biological approach can produce effective treatment.Drugs only treat the biologically-visible effects, not the causes of problems. Childhood experiences that cause trauma and depression during adulthood may be better treated by confronting our past than by using anti-depressants. Different with biopsychology,Comparative psychology often utilizes the comparative method to study animal behavior. The comparative method involves comparing the similarities and differences among species to gain and understanding of evolutionary relationships. The comparative method can also be used to compare modern species of animals to ancient species.  The study of animal behavior can lead to a deeper and broader understanding of human psychology. Research on animal behavior has led to numerous discoveries about human behavior, such as Ivan Pavlov’s research on classical conditioning or Harry Harlow’s work with rhesus monkeys. Students of biological sciences and social sciences can benefit from studying comparative psychology. The strengths of the comparative psychology is that it is easy to find out and analyse the statistics of human psychology and the results are always believable.In addition,it is also clear to show the relationships between different variable quantities.However,there is a weakness that it is hard to find out the conclusion of the cause and effect and the experiments are always inflexible.Also,most of the experiments require a lot of manpower and material resources.  If the approaches are compared in terms of the nature – nurture debate, common ground is found, both believe an individual’s personality develops as they grow, therefore, they are on the nurture side of the argument as opposed to nature, which suggests people are born with genetic dispositions and only possess innate, inherited personality. (Carlson 1990) In conclusion both have fundamental differences and share many attributes, comparative psychologists believe the unconscious has no bearing on behaviour, opposed to biology psychologists’ belief that unconscious drives are the reason we behave as we do, one is scientific, the other isn’t and they both use very different therapies to treat patients. The similarities between the approaches begin as far back as evolution and Darwin’s theory, they share determinism and both fall into the nurture side of the great debate.  However, it is fair to say, that even with their many differences and similarities, these approaches have made the biggest contribution to this ‘science of the mind’ and made history with different therapeutic techniques. Reference lists Simmon Green(1994) Principles of Biopsychology. Lawrence erlbaum associates ltd.  John P.J Pinel(1999) Biopsychology . A Pearson Education Company.

A Broken Class System. The Misuse Of Drugs Act 1971...

A Broken Class System? The misuse of drugs act 1971 implements a class system for different types of drugs based, supposedly on the dangers they pose to both users and society in accordance with the United Nation commission on narcotic drugs. Class A, the most dangerous of drugs, contains such drugs as heroin and crack cocaine as well as MDMA, LSC and magic mushrooms. The maximum penalty for class A offenses is life imprisonment. Class B includes amphetamines, barbiturates and cannabis among others and Class C contains such drugs as tranquilisers, ketamine and anabolic steroids. So according to the classification of drugs in the UK, it’s fair to assume that the most dangerous drugs are Class A, but research and evidence suggests this is†¦show more content†¦16% of men and 9% of women respondents to the survey had drank on five of the proceeding seven days. 34% of men and 28% of women had consumed more than the recommended daily allowance at least once in the past week. The Nation Health Service estimates that around 9% of men and 4% of women show some signs of alcohol dependence. There are zero cases where cannabis was proved to be the cause of death. While it is true that the effects of cannabis can lead to death, to die directly from cannabis consumption, per G.T. Carter et al (2004), you would have to consume 628kg of cannabis would have to be taken in 15minutes. It is quite literally impossible to die from cannabis consumption alone. When compared to alcohol it remains baffling as to why one is illegal and one is not. Office of National Statistics figures show that for 2014 there were 8697 cases of alcohol related deaths in the UK alone, a rate of 14.3 deaths per 100’000. This number has fallen from 2008 when there the rate stood at 15.8 deaths per 100’000, yet is still higher than the figures of twenty years ago. This is one glaring example of the dangers to both the user and society at large of alcohol when compared to cannabis. So, what are the reasons behind cannabis being illegal? Advocates for the keeping cannabis prohibition in the UK, and in other countries round the world argue that, Cannabis causes psychosis, Cannabis is a gateway drug; leading to experimentation and use of ‘harder’ drugs. They argue thatShow MoreRelatedInfluence of Drug and Alcohol Abuse Amoung Kenyan Teenage Education5708 Words   |  23 PagesSCHOOL OF COMPUTER SCIENCE RESEARCH PROPOSAL. Influence of drug and alcohol abuse among Kenyan teenage Education. BY BRIAN MUNGA (J15-3021-11) TAKEN BY: Catherine Mavyala DECLARATION I declare that Influence of drug and alcohol abuse among Kenyan teenage Education is my own work and that all the sources that I have used or quoted have been indicated and acknowledged by means of complete references. †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 07 August 2012 SignatureRead MoreThe Most Controversial American Presidents9333 Words   |  38 Pagesfirst major sectional party by the mid-1850s, the old Second Party System collapsed and a realignment created the Third Party System. It became the stage on which sectional tensions were played out. Although little of the West–the focal point of sectional tensions– was fit for cotton cultivation, Southern secessionists read the political fallout as a sign that their power in national politics was rapidly weakening. The slave system had been buttressed by the Democratic Party, which was increasinglyRead MoreInternal Threats to Pakistan10157 Words   |  41 Pagescrucial, decisive and a critical juncture of our history, the requirement of unity, cohesion and harmony among all segments of society is much more than ever anticipated. There is a dire need to critically analyze the problem areas and forthrightly implement suitable measures before the situation blows out of proportion. 4. Aim. The aim of this paper is to carryout an in-depth study of the emerging dynamics of internal threats to national security of Pakistan and make suitable recommendations toRead MoreHemp Cultivation in China42289 Words   |  170 Pagesimproved hemp varieties. Continued on pg. 60 Shandong cultivation 57 Letters 59 Fiber hemp cultivars 66 Medical Cannabis review 74 New cannabinoid antiemetic 76 Ukranian seed 79 Tasmanian research 82 Interview 86 ICRS symposium 88 Colorado hemp act 92 Canada report 96 Austria report 98 German textiles 101 Book reviews 103 NAIHF 104 Debate Corner 106 Journal of the International Hemp Association, Volume 2, Number 2, 1995 58 DEAR MEMBERSHIP First, we owe our readers and authors an apologyRead MoreMedicare Policy Analysis447966 Words   |  1792 PagesTITLES, rmajette on DSK29S0YB1PROD with BILLS 4 5 AND SUBTITLES. (a) SHORT TITLE.—This Act may be cited as the 6 ‘‘Affordable Health Care for America Act’’. VerDate Nov 24 2008 12:56 Oct 30, 2009 Jkt 089200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H3962.IH H3962 2 1 2 (b) TABLE TITLES.—This OF DIVISIONS, TITLES, AND SUB- Act is divided into divisions, titles, and 3 subtitles as follows: DIVISION A—AFFORDABLE HEALTH CARERead MoreFundamentals of Hrm263904 Words   |  1056 PagesCopyright  © 2010, 2007, 2005, 2002 John Wiley Sons, Inc. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, scanning or otherwise, except as permitted under Sections 107 or 108 of the 1976 United States Copyright Act, without either the prior written permission of the Publisher, or authorization through payment of the appropriate per-copy fee to the Copyright ClearanceRead MoreHow Pastoral Care Policy Has Contributed to the Management of Junior Secondary Schools In Botswana23474 Words   |  94 Pagesabsence. May the good Lord repay their patience and endurance. We are forever indebted to God Almighty who kept us healthy and supplied us with divine energy throughout our study. He in a miraculous way bound us together with strings that could not be broken to the end of the study. Last but not least are our colleagues at the various junior secondary schools that we interviewed who took time out of their tight schedules and assisted us with the information we sought for our study. Read MoreHuman Resources Management150900 Words   |  604 Pagesorganizational competitiveness and success.1 4 Section 1 HR Management—Strategies and Environment â€Å" HR should be defined not by what it does, but by what it delivers. DAVID ULRICH Human Resource (HR) management The design of formal systems in an organization to ensure the effective and efficient use of human talent to accomplish the organizational goals. As human resources have become viewed as more critical to organizational success, many organizations have realized that it is theRead MoreThe Marketing Research of Brainquiry33782 Words   |  136 Pagesmentioned the ad specifications and no prices. All prices can be obtained when ordering a spot for advertising. Conclusion Through the extensive research done on New York State it can be seen that there is a very large market. This market is mainly broken down into Doctors, Patients and Golf Associations. In reviewing these topics one can also see that there are many more doctors that could be listed making the doctor market even bigger therefore the doctor market can be a very large target. ThereRead MoreCorporation (Fisch) Outline Penn Law Essay62808 Words   |  252 Pagesis virtually impossible for courts/legislatures to make important decisions that do not make someone worse off ââ€" ª Kaldor-Hicks Efficiency: (Business law model) *Increases aggregate well-being* Fairness model †¢ An act/rule is efficient (leads to overall improvement in social welfare) if at least one party would gain from it after all those who suffered a loss as a result of the transaction or policy were fully compensated (but those who suffer do not actually have