Recognizing Sepsis and Septic Shock in Nursing Homes
Could your loved one’s confusion or fever in a nursing home be a sign of deadly sepsis? Sepsis and septic shock can develop quickly in nursing home residents, often going unnoticed until it’s too late. Early recognition and treatment are critical to saving lives. In this week’s episode, nursing home abuse lawyer Rob Schenk welcomes guest Jessica Shaffer to talk about how to spot the warning signs of sepsis in nursing homes and what steps staff should take to protect residents.
Shaffer:
But recognizing the difference between, these are signs of an infection and now we’re moving into that realm of where sepsis could be brewing. That’s when they have to be trained to recognize the difference between, this was just an infection, but now we’re getting into a dangerous realm in the elderly population. That can happen very quickly. Click.
Schenk:
Hey, out there. Welcome back to the Nursing Home Abuse Podcast. My name is Rob. I’ll be your host for this episode. Today we’re talking all about recognizing the signs and symptoms of sepsis, talking about what the difference is between sepsis and any underlying infection. But we’re not doing that alone. We had the fantastic Jessica Shaffer on with us today. It’s gonna be great conversation, so stick around for that. We’re not having that conversation about sepsis alone. No, sir. No ma’am. We are having that conversation with Jessica Shaffer, the fantastic Jessica Shaffer.
Jessica is a US Navy veteran and aviator with 25 years of tactical training and expertise that she applies to her nursing practice and consulting services at the aptly named. Tactical Legal Nurse Consulting. She has a bachelor’s degree in nursing and with experience in pre-hospital transport, medical, surgical wound care and emergency medicine.
She has also served as a nursing union officer. Been a staffing and safety committee member and led contract negotiations. She specializes in audit, trail analysis and case strategy development, and we’re so happy to have her on the show. Jessica, welcome to the show.
Shaffer:
Thank you. A pleasure to be here.
What is Sepsis? What is Septic Shock?
Schenk:
So I was driving down the street.
Of let me just say this. I’m in Atlanta, so like I’m driving down the street and every, you can throw a baseball and hit a billboard for an attorney. And for the first time that I’ve seen, usually it’s one call, whatever, or, been hit, call Flit or whatever it is.
This, I saw a billboard for the first time. Where it just said sepsis kills X amount of people every single day. And that was the billboard and call whatever attorney. So I was like, that’s interesting. I think it’s probably a good idea because I don’t know if the public really knows a lot about sepsis or septic shock.
So that’s how I wanted to have this conversation with you. So the kind of the first softball question for you, Jessica, is walk us through what sepsis is and why would there be a billboard about it?
Shaffer:
Sepsis is an in, it starts as an infection, but the sepsis itself is an inflammation or inflammatory response within the body.
So it can lead, it’s, it’ll start as an infection, then the body reacts to that infection. And things start to get inflamed, and that inflammatory response can continue to develop. If it develops, too much, or there’s no intervention to stop that, inflammation process, then it can go into severe sepsis and ultimately septic shock.
And so the difference between, early on sepsis and sepsis shock is organ damage or organ failure. So it can go from a very small infection. All the way to organs are shutting down and people are done.
Review the latest research on the impact of preventive health measures in elderly populations.
Schenk:
I and this was something that I didn’t know any about any of this until I became an attorney, but I I guess sepsis is separate and apart from the underlying infection, which correct me if I’m wrong, is the driver, like you can’t have sepsis if you didn’t have an initial infection,
Shaffer:
Correct. It’s not a, it’s not an infection in and of itself, it’s the response to the infection.
What are the most common infections that lead to sepsis in nursing homes?
Schenk:
So what is the what would be, at least in a long-term care setting, what are some of those infections that are more likely to develop into sepsis?
Shaffer:
So the two. I guess I should say three biggest culprits in a long-term care facility are urinary tract infections that develop into u ssis.
Pneumonia can often develop into sepsis and then wounds will develop osteomyelitis or they can go directly into the bloodstream that, osteomyelitis is where it goes into the bone. And then, sepsis is where it goes in, into the bloodstream and, goes across the entire body as a whole.
Discover findings on sepsis management and prevention strategies in long-term care settings.
Schenk:
So if I understand correctly, anybody that has developed these three infections is particularly those that are, in long-term care. ’cause they have a lot of clinical conditions that might make them, more weak or more susceptible to problems. They’re on a, they’re on a potential trajectory for sepsis.
What are some of the early signs of sepsis?
Schenk:
Correct. So what are some of the signs that an individual. Not just has an infection, but is potentially developing that inflammatory response that first the first the first signs of sepsis. What are those observable signs?
Shaffer:
So I’ll use urinary tract infections because that’s the most common and often has the most, the signs that are the most prevalent. For example, if someone starts to develop a urinary tract infection, they’ll show signs of increased frequency or urgency with needing to go to the bathroom f in a more quicker manner. Oh, I gotta go now. Incontinence where they weren’t incontinent before those are the very early signs of an infection brewing.
Then other signs are, blood in the urine. Where the urine becomes cloudy, very malodorous those are the more advanced signs of the infection is continuing to brew. Then as you’re getting into the area of sepsis, you could have difficulty breathing where they started out with, having these urine signs and symptoms that went either unrecognized or untreated, and now they’re having difficulty breathing.
Learn about recent studies on infection prevention protocols in nursing homes.
They may be confused or showing signs of altered mental status. They could be developing a high fever, and then as it goes into either further more severe sepsis or into that shockey realm, then they could become rapid heart rates, shallow breathing. Very low drops in blood pressure. They’re, they, maybe they had a slight fever the day before and now they’re hypothermic, their temperature drops down into the 96 range, and that’s the body’s reaction to that sepsis, trying to protect the vital organs.
So as it progresses, you’re gonna see more and more signs and symptoms develop, and they’re gonna get progressively more severe.
Explore evidence-based practices on managing sepsis in older adults.
Schenk:
I think that, ’cause I’m a non-clinician, so some of this can get confusing for me. But it seems to me that at least some of the symptoms of sepsis, which is a separate condition than the infection, some of the symptoms of the sepsis seem to be the same symptoms as the infection itself.
How can you tell the difference? Or does it matter? In other words, does the average nurse go, look, if we have the signs of infection, let’s just assume that there’s sepsis, like walk me through that process.
Shaffer:
So not necessarily a well-trained nurse should always be thinking ahead.
So if there are signs of infection, they have to be aware that, hey, if we don’t get an interaction now or if we don’t intervene, sepsis could develop. But just because there’s an infection doesn’t mean sepsis will develop. But recognizing the difference between these are signs of an infection and now.
We’re moving into that realm of where sepsis could be brewing. That’s when they have to be trained to recognize the difference between. This was just an infection, but now we’re getting into a dangerous realm and in the elderly population that can happen very quickly.
Understand advanced care strategies on preventing infections in frail nursing home residents.
Schenk:
So how quickly are we talking in terms of moving from a bad infection to the beginnings of sepsis?
Is that, are we talking days, weeks, minutes, hours.
Shaffer:
It could be days to hours, depending on the comorbidities that individual has and the their ability to fight an infection. So if it’s a relatively healthy individual, they may be able to fight off sepsis for a long time. It could take. Days, weeks, months, even.
If it’s like a minor brewing, well controlled infection or if it’s someone who’s immunocompromised or on chemotherapy or frail or malnourished, there’s, insert whatever comorbidity you want. Someone can go from a severe infection to sepsis in a matter of hours.
Read our clear explanation on what sepsis and septic shock are in nursing home contexts.
Schenk:
So when you’re talking about a well experienced tactical, if you will, nurse thinking ahead.
You’re thinking ahead potentially for hours, depending on how many, what the clinical condition is of that particular resident. You gotta be, you gotta be thinking, not weeks in advance, but maybe hours in advance. So tell me walk me through that then. So what are the interventions that you’re going to put into place typically for a resident that is showing those signs of sepsis?
Is it, you’re calling the attending physician for orders or walk? Walk me through that.
Shaffer:
Hopefully you’ve caught the infection well before that ever happens. And I personally believe that urinary tract infections are one of the most preventable infections, especially in a long-term care facility.
Learn your legal rights if your loved one died of sepsis at a nursing home.
But unfortunately they tend to be the most prevalent. So when you do recognize that something is moving into that realm of sepsis or potentially developing sepsis, or you’re concerned that, you could be heading in that direction, the first phone call needs to be to that primary care provider or, the on, on staff physician, whoever is most easily available.
If that is not something that they can react to within, an hour, then they need to be transferred to the local emergency room where they can be treated properly.
Schenk:
I see. And then there’s the, I guess it would, it’s, I hear sometimes it called like the sepsis protocol where like you’re getting, a certain amount of antibiotics until we can figure out exactly what, what’s going on from a lab result.
What policies should change to reduce sepsis cases in long-term care?
Correct. What kind of policies, like from a broader standpoint, what are some of the policies and procedures that a long-term care facility could put into place to minimize the risk in the injuries from sepsis.
Shaffer:
So if we work backwards, having a sepsis protocol in place, that includes notifications, recognizing signs and symptoms, policies for hospital transfer, possibly starting fluids and starting that broad spectrum.
Antibiotics if. Having that in place when the sepsis signs and symptoms are recognized and being able to go through that policy and procedure, that could save a lot more lives. But in my opinion, it has to start way before that. It has to start on the other end of the spectrum, and those are policies and procedures that a lot of these facilities already have in place, but don’t recognize as.
Learn about common infections found in nursing home residents in our podcast episode.
Policies that could lead to sepsis, like hygiene, bathing, ensuring that, residents are getting their baths every, every week or biweekly depending on the facility and the standards, doing proper skin assessments. Making sure that there’s proper nutrition in place, that we’re pressure relieving, that we’re preventing the infections from ever starting.
So it has to be attacked from both ends of that spectrum. I. So we have to do the preventative work, and then we have to have the recognition and training to cover that middle ground. So making sure that there’s staffing that’s trained to recognize, the early signs of infection, as well as the early signs of sepsis.
Learn how sepsis and septic shock develop in long-term care in our podcast, Nursing Home Sepsis and Septic Shock.
We have to have proper assessments in place. We have to have licensed certified caregivers, that are medically trained rather than just having, unlicensed care staff that may not understand that, when. Client A is more confused than he was today. It isn’t just because he’s aging, it’s because he may have an infection brewing, or when client B’S dentures are no longer fitting properly and they’ve stopped eating and they’ve lost weight, that their body doesn’t have the nutrients to fight off.
Infections. So it’s just as important to go from that full preventative spectrum as it is to recognizing the signs and symptoms of sepsis itself and being able to react appropriately.
Hear practical guidance on how to prevent sepsis in Georgia nursing homes.
Schenk:
I see that you’re a 25 year Navy veteran. How many of those years are, were as a nurse in the Navy?
Shaffer:
Zero.
Schenk:
Zero. Okay.
Shaffer:
Zero. I was a naval flight officer, so Goose Top Gun if you’re familiar with the movie. Cool. I had never wanted to do anything in healthcare. Most of my family was nurses and I went off to do great things and fight for our country with my hair on fire, basically. But one of the things that I did while I was in the Navy, I was stationed on a small island out in Washington and I joined our volunteer firefighting.
Understand the risks and prevention of aspiration pneumonia in nursing homes.
Organization, the fire department as a, as an emergency response technician in EMT. And so I fell in love with emergency medicine and I did that for years. And then when the Navy told me I had to grow up and get a real job, I didn’t. I didn’t want to do the, tactics and strategy that I had been doing for the 25 years that I was serving and work for a three letter identifier, the F-B-I-C-I-A-N-I-S, any of those fun things.
Discover when nursing homes can be held liable for infections in our informative discussion.
I wanted to do something different. And so I took, my emergency medicine training. I said maybe I’ll go do something in, in medicine. I. Went to nursing school, fell in love with nursing school, in the nursing profession. And then slowly developed my nursing career and then started applying all of my tactics and strategy training to analyzing medical records and doing root cause analysis and the breakdown of these larger hospital systems and these nursing home systems to identify, where the problems are.
And so I combined that, in military intelligence and nursing intelligence and. This is where I am today.
Listen to strategies for infection control in nursing homes to protect residents.
Schenk:
That’s an amazing story. And Jessica thank you again so much for coming on the show and sharing your knowledge with us.
Shaffer:
Absolutely. Anytime.
Schenk:
Folks, I hope that you found this episode educational and entertaining.
If you did, please let us know. If you have an idea for topics that you would like for me to talk about, please let me know that. If you have any suggestions for people that you would like for me to talk to, let me know that as well. New episodes of the Nursing Abuse Podcast come out every single Monday and don’t.
Please don’t forget that I have a million of these coffee mugs, so if you just let me know you, you want, it’s yours. Have ’em all. Who? Who am I? So enter the contest please, and with that folks. We’ll see you next time.
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