Reading between the lines of an adult sepsis pathway : why and how nurses can initiate change

Nurses are acclaimed critical thinkers practising in numerous specialties such as emergency departments where patients regularly present with life threatening conditions requiring timely intervention by nurses. While many milestones have been achieved in the critical thinking journey of nurses, some low performance areas make us consider why and what barriers stop nurses from initiating treatment. A relevant example is the timely initiation of intravenous fluids (IVF) in patients with sepsis or severe infection. Studies show lack of adherence to early fluid resuscitation (Bentley et al. 2016; Leung et al. 2017). Severe sepsis can quickly progress to multi organ failure if adequate IVF are not commenced within the recommended timeframe of 30 minutes (Miller 2014). Despite compelling evidence of urgency, application of this recommendation seems lacking.