Nurse-Driven Fluid Responsiveness Evaluation in Patients With Septic Shock: A Quality Improvement Initiative

Area of Science:

• Critical Care Medicine
• Nursing Practice
• Hemodynamic Monitoring

Background:

• Assessing fluid responsiveness is crucial in septic shock, as only 50% of patients respond to fluids.
• Dynamic measures like pulse pressure variation (PPV) after passive leg raise (PLR) are recommended for guiding fluid administration.
• Fluid overload and acute kidney injury (AKI) are significant complications in septic shock management.

Purpose of the Study:

• To evaluate the impact of a nurse-driven protocol for fluid responsiveness assessment in septic shock patients.
• To assess changes in fluid overload, AKI incidence, mechanical ventilation duration, and ICU length of stay.
• To measure the effect on nurse satisfaction and perceived autonomy.

Main Methods:

• A prospective project involving 30 adult septic shock patients in a medical-surgical ICU.
• Implementation of a bedside nurse-driven protocol using PLR and PPV for fluid responsiveness evaluation.
• Collection of pre- and post-intervention patient outcome data and staff satisfaction surveys.

Main Results:

• A 28% decrease in the incidence of fluid overload was observed post-intervention.
• Pre-intervention, 65% of patients experienced fluid overload; this incidence was reduced.
• Nurses reported increased feelings of empowerment and found the new process efficient.

Conclusions:

• Nurse-driven fluid responsiveness evaluation using PLR and PPV positively impacted patient outcomes.
• The project enhanced nurse autonomy and satisfaction in managing septic shock patients.
• This approach offers a valuable strategy for optimizing fluid management in ICUs.