Code Sepsis

By: Debbie Moore-Black, RN

It was a known fact. I was 4’11” but I had a mouth on me to compensate. I was loud and noisy. Fellow nurses called me the “Rebel without a cause.”
But I had a cause. I knew I was Samson against Goliath.
Most everything became my cause.
So I verbally fought my way through this iron-clad heavy management structure.
I had to fight for the betterment of the patients. For their survival.
I had to fight for the nurse that was being bullied.
I had to fight in front of an all management team that failed to uphold a safe 2:1 patient/nurse ratio.

I was invited to a grand Sepsis protocol debate.  The Sepsis protocol rolled out around 2003. This big meeting held Critical Care managers from ICU, Neuro-ICU, Coronary Care Unit and The Emergency department, Pharmacists, Respiratory Therapists, ER Physicians, and Intensivists and other important medical representatives across the country.
And I was invited to this “Think tank.”
I was the little fish in this big pond.

“Code Sepsis”
And at this round table with Heath care professionals who were use to pounding their chests on how good they set up this Sepsis protocol, I had to debunk it.

Sepsis was the new named diagnosis and if not treated rapidly and proficiently a patient could die.
Our numbers showed that our patients were dying.
Cardiac patients have the “golden hour”.
The sepsis patient had the golden hour also.
Sepsis: a raging infection that consumes most organs. Bacterial, viral or parasitic infections.
The symptoms: shortness of breath, dizziness, confusion, rapid heart rate, low blood pressure.

At our institution, a sepsis patient stayed in the ER for hours. Strategic life-saving protocols were stalled and when the patient eventually got to the ICU, precious hours had been missed.
We had to intubate these patients. Put in a stat central line and arterial line. Hang vasopressor drips, get stat labs and administer IV antibiotics. And add liters of IV Normal Saline.
The entire body had to be resuscitated.

I mentioned in the round table that we were doing it all wrong.
I recommended  a “Code Sepsis” should be announced overhead. The Rapid Response Team (RRT) should respond to the ER stat. A central line should be inserted stat and an arterial line. Stat labs. To include a lactic acid level, ABG’s, intubation, electrolyte profile, liver function tests, and kidney function tests.
All in all these procedures had to be preformed stat and simultaneously.
But they weren’t. They came to the ICU after being in the ER for several hours. Precious wasted hours. Precious minutes.

The round table got loud and argumentative.
But we began to settle on the truth. That we weren’t being aggressive enough, medically. And our patients were dying.
Protocols were rewritten and added too.
We fine tuned.
As an aftermath of this “think tank”, Code sepsis was now  called out overhead. The RRT showed up in the ER and with rapid succession of intubation and central line insertion, the patient was rushed to our ICU with the goal of one hour.

Feeling that I productively had added my 2 cents worth, 2 weeks later I was called to the manager’s office.
Our manager told me I was brilliant, my ideas were also “their ideas”.
BUT… she had to write me up.
Why?  Because I spoke “out of term”.
I intruded amongst these professionals. I was out of place.
In years to come, at this institution, I realized that they had to be the ones in control. They had to be the ones with the ideas.
I was just that brick in the wall and they wanted me to close my mouth.
I carried on relentlessly for the betterment of the patients and fellow nurses…. Until I could no longer feel any support.

They wanted me to be a yes person.
To serve, honor and obey.

Lesson learned: pick your battles!!

(Google stock photo)