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Publication Date
6-2021
Keywords
2021 prov rn wa; 2021 prov rn poster; washington; spokane; phfmc
Disciplines
Nursing
Abstract
Background: Sepsis is the number one cause of mortality in hospitals nationwide. Our hospital system has identified sepsis mortality reduction as a top priority. Early recognition and treatment through improving sepsis bundle compliance was the selected focus in a 40-bed Emergency Department (ED) a community-based hospital.
Purpose: To evaluate the impact of a team response to sepsis alerts on sepsis outcomes in the ED in an acute care hospital.
Methods: Prior to implementing a team approach to sepsis alerts, ED staff were surveyed to describe awareness of SIRS and sepsis criteria and of sepsis bundle intervention metrics. Challenges identified were obtaining IV access, labs, 2 blood cultures, initiating IV fluid resuscitation and administering antibiotics in a timely manner. As a result, this quality improvement team created a team sepsis response, where two RNs respond to a room when a sepsis alert is called to "Team Up Against Sepsis". Together, the pair completes the following six evidence-based practice tasks within sixty minutes of the sepsis alert: 1) Blood collection: CBC, CMP, PT/INR, Procalcitonin, and Blood cultures x 2; 2) Lactate collected and placed on ice; 3) Urine collection; 4) Fluid resuscitation at 30 ml/kg; 5) Oxygen status is monitored/maximized; 6) Administer ordered antibiotic, if applicable. The pair will divvy up these six tasks including documentation to drive faster sepsis diagnosis and treatment. The quality improvement team educated nursing staff on using the new sepsis team response to every sepsis alert in the ED and also placed a card of the six sepsis tasks on all ED computers as a visual reminder of the project. Results: Pre-implementation was in the middle of the year 2019, and at that time, on average, the time from sepsis orders to antibiotic was 141.5 minutes; sepsis alert called to antibiotic administered was 221 minutes; blood culture order to collection was 53.32 minutes; IV fluids order to administration was 67.70 minutes. Post-implementation data was measured for the beginning of the year 2020 and all times decreased: Sepsis orders to antibiotic was 51 minutes on average; alert called to antibiotic was 79 minutes; blood culture order to collection was 59 minutes, and IV Fluids order to administration was 59 minutes. Last, there was a decrease in observed versus expected sepsis-related mortality from 1.15 at the beginning of the project to 0.66 at the post-implementation time point.
Conclusion: Teaming Up Against Sepsis had a positive impact in improving identification and treatment of sepsis in the ED with a significant reduction in observed versus expected sepsis related mortality rates. The team approach to sepsis alerts has been adopted as a best practice in this ED. Next steps include implementation of this approach at other ED’s within this hospital system and continual evaluation of sepsis outcomes.
Specialty
Nursing
Conference / Event Name
2021 Providence RN Conference
Location
Virtual Conference
