Roles and responsibilities of registered nurses in the early recognition and management of sepsis in acute hospital settings: a scoping review.

Abstract

Sepsis causes over 20% of deaths annually, with early recognition and management being key strategies to preventing patient deterioration. Despite being the largest group of hospital-based clinicians, the role of registered nurses (RNs) in sepsis remains poorly defined. To describe the roles and responsibilities of RNs in early recognition and management of sepsis in acute hospital settings, applying the <i>Action, Actor, Context, Target</i> and <i>Time</i> (AACTT) Implementation Science Framework to specify nursing behaviours across domains, and identify evidence gaps to inform future research and practice. The review was conducted using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist. We searched Medline, EMBASE, CINAHL and PubMed for studies discussing the contribution of RNs in acute hospital-based sepsis care. Data were extracted and mapped to the AACTT framework domains. 27 (90%) of 30 included studies described RNs as the <i>actor</i> responsible for the <i>action</i> of sepsis screening. 26 studies (87%) described RN <i>actions</i> relating to timely care escalation and sepsis management. A broader range of <i>actions</i> was identified in resource-restricted <i>contexts,</i> with three (10%) studies reporting RN-initiated blood tests, chest X-rays, intravenous fluids and antimicrobials.Across 16 studies (53%), eight roles with dedicated focus on sepsis identification and management were identified; only one study outlined formal training requirements. Nurse practitioners were excluded here given their credentialed role and scope. Nurses perform essential actions in early sepsis recognition and management, with several RN roles focused on sepsis care identified. A broader scope of nurse-initiated actions was identified in resource-restricted contexts to meet clinical demand. There is potential for a greater scope of nursing actions in sepsis care for the benefit of patients and health services, but to achieve this, standardised training requirements need to be developed, and scope of practice defined.