Recognition and management of sepsis: the nurse's role.

Caring for a patient with suspected sepsis is a challenging nursing role. Early recognition and appropriate management of a patient with sepsis saves lives. Nurses play a fundamental role in detecting changes in physiological observations that could indicate the onset of sepsis. Additionally, an awareness of the pathophysiology of sepsis allows the nurse to better understand how rapid intervention prevents the onset of septic shock. Furthermore, knowledge and use of clinical guidelines and sepsis screening tools are established methods to help reduce patient mortality. Nurse familiarity with 'red flag' criteria for sepsis and thorough completion of early warning scores facilitate earlier recognition and time critical intervention. Delivery of the 'sepsis six' within 1 hour of suspected sepsis saves lives.

Organ donation: reducing the risk of health care-associated infection.

Health care-associated infection is a real and relative risk within the realm of organ donation. Despite detailed guidance from the Advisory Committee on the Safety of Blood, Tissues and Organs on the microbiological safety of human organs, tissues and cells used in transplantation, the topic has received limited exposure in the literature. This paper will give a context to the Safety of Blood, Tissues and Organs guidance, outline the key recommendations for mandatory/recommended screening and provide a summary of infections that may be present at the time of donation that require careful risk assessment. This does not detract from national guidelines and cannot replace expert advice but will raise awareness and complement safe and effective care delivery.

Implementing minimum notification criteria for organ donation in an acute hospital's critical care units.

AIMS AND OBJECTIVES: To increase the number of donated organs through an effective donor identification and referral scheme in a large acute hospital's critical care units. BACKGROUND: The barrier to successful organ transplantation is a serious shortage of donated organs. In January 2008, the Department of Health officially endorsed all 14 recommendations presented by the Organ Donation Taskforce. Recommendation 5 from the Taskforce is that minimum notification criteria for potential organ donation should be introduced on a UK-wide basis. DESIGN: A hospital policy entitled Required Referral was implemented into a large hospital trust consisting of four critical care units. Support from the trust board was sought and it was agreed that the policy would be implemented as a 'pilot policy' in the first instance, then a formal review after a 6-month period. A rolling education programme was instituted to incorporate 170 clinical staff to ensure the policy was activated with the following criteria: If the plan is to perform brain stem death tests on a patient or a clinical decision is made to withdraw treatment, the on-call donor transplant co-ordinator is contacted for an assessment of suitability. RESULTS: A significant increase in potential donor referrals and a 200% increase in donated organs has been achieved with the policy in place. A retrospective audit for the 6-month period prior to the policy launch had shown four referrals from the pilot sites. The following 12 months as the policy was implemented revealed an impressive 121 referrals to the transplant co-ordinator. This has resulted in nine successful multi-organ donors. CONCLUSION: The required referral scheme has clearly shown an impressive increase in donation activity within the trust. Donation has been embraced as a normal part of end of life care.