Location
Virtual
Start Date
1-3-2024 9:10 AM
End Date
1-3-2024 9:25 AM
Keywords:
california; phcmc
Description
Abstract
Background:
Sepsis can be a source of morbidity and mortality particularly when there are delays in treatment. Early identification may improve time to antimicrobial administration. The quick Sequential Organ Failure Assessment (qSOFA) is an evidence-based practice screening tool that, when in used in conjunction with the Systemic Inflammatory Response Syndrome (SIRS) criteria can enhance recognition and treatment of sepsis. On a suburban Southern California hospital Neurological/Telemetry Unit the qSOFA is automatically calculated in the electronic medical record (EMR) but the bedside nurses were unaware of its availability and value. In addition, sepsis was not being identified in a timely manner.
Purpose:
To determine if educating bedside nurses on the availability and value of the qSOFA screening tool would impact the time between sepsis criteria being met and antimicrobial administration.
Approach:
This quality improvement project educated nurses on how to find and interpret the qSOFA as an additional strategy to SIRS criteria to recognize sepsis earlier and administer antimicrobials sooner. The qSOFA score is derived from systolic blood pressure, respiratory rate, and Glasgow Coma Score (mental status) and ranges from 0-3, with >1 screening positive for sepsis. The SIRS criteria considers vital signs and labs and a patient screens positive for sepsis if they have 2+ criteria and a possible source for infection. An evidence-based presentation was developed teaching nurses the value of the qSOFA and how to find and use it in addition to the standard of practice using SIRS criteria. Adults meeting criteria for sepsis eight weeks before and after the education had data extracted from the EMR to determine the time the patient met sepsis criteria and the time to antimicrobial administration. An independent t-test was used to evaluate changes in time (in minutes) of antimicrobial administration in the pre- and post-implementation groups.
Results:
All nurses in the unit received at least one mode of education. The pre-education group had n=7 patients and the post-education group had n=13 patients. No statistically significant differences were found between the groups t (14) = -.133, p=0.896. However, clinical significance was identified with a reduction of the time to antimicrobial administration by 8.84% from 228.4 minutes in the pre-education group to 208.58 minutes in the post-education group.
Conclusion:
There was no statistically significant difference in our project from sepsis identification to antimicrobial administration between groups. However, a clinically significant difference emerged as arguably 20 minutes could make the difference in determining the need for a higher level of care. Continued efforts will be made to evaluate the impact of using the qSOFA on this metric as well as to engage more interdisciplinary stakeholders on the value and use of this tool.
Implications for practice:
Educating nurses to accurately identify and use the qSOFA screening tool alongside SIRS criteria could contribute to early sepsis identification and therefore early antibiotic administration. Nurses who treat patients with sepsis could benefit from incorporating the use of qSOFA alongside SIRS criteria to enhance recognition and response time to sepsis.
Recommended Citation
Adams, Jeanna, "Management of Sepsis with the quick Sequential Organ Failure Assessment" (2024). Providence Nursing Research Conference 2023 – Present. 7.
https://digitalcommons.providence.org/prov_rn_conf_annual/2024/podiums/7
Department
Critical Care Medicine
Department
Nursing
Included in
Management of Sepsis with the quick Sequential Organ Failure Assessment
Virtual
Abstract
Background:
Sepsis can be a source of morbidity and mortality particularly when there are delays in treatment. Early identification may improve time to antimicrobial administration. The quick Sequential Organ Failure Assessment (qSOFA) is an evidence-based practice screening tool that, when in used in conjunction with the Systemic Inflammatory Response Syndrome (SIRS) criteria can enhance recognition and treatment of sepsis. On a suburban Southern California hospital Neurological/Telemetry Unit the qSOFA is automatically calculated in the electronic medical record (EMR) but the bedside nurses were unaware of its availability and value. In addition, sepsis was not being identified in a timely manner.
Purpose:
To determine if educating bedside nurses on the availability and value of the qSOFA screening tool would impact the time between sepsis criteria being met and antimicrobial administration.
Approach:
This quality improvement project educated nurses on how to find and interpret the qSOFA as an additional strategy to SIRS criteria to recognize sepsis earlier and administer antimicrobials sooner. The qSOFA score is derived from systolic blood pressure, respiratory rate, and Glasgow Coma Score (mental status) and ranges from 0-3, with >1 screening positive for sepsis. The SIRS criteria considers vital signs and labs and a patient screens positive for sepsis if they have 2+ criteria and a possible source for infection. An evidence-based presentation was developed teaching nurses the value of the qSOFA and how to find and use it in addition to the standard of practice using SIRS criteria. Adults meeting criteria for sepsis eight weeks before and after the education had data extracted from the EMR to determine the time the patient met sepsis criteria and the time to antimicrobial administration. An independent t-test was used to evaluate changes in time (in minutes) of antimicrobial administration in the pre- and post-implementation groups.
Results:
All nurses in the unit received at least one mode of education. The pre-education group had n=7 patients and the post-education group had n=13 patients. No statistically significant differences were found between the groups t (14) = -.133, p=0.896. However, clinical significance was identified with a reduction of the time to antimicrobial administration by 8.84% from 228.4 minutes in the pre-education group to 208.58 minutes in the post-education group.
Conclusion:
There was no statistically significant difference in our project from sepsis identification to antimicrobial administration between groups. However, a clinically significant difference emerged as arguably 20 minutes could make the difference in determining the need for a higher level of care. Continued efforts will be made to evaluate the impact of using the qSOFA on this metric as well as to engage more interdisciplinary stakeholders on the value and use of this tool.
Implications for practice:
Educating nurses to accurately identify and use the qSOFA screening tool alongside SIRS criteria could contribute to early sepsis identification and therefore early antibiotic administration. Nurses who treat patients with sepsis could benefit from incorporating the use of qSOFA alongside SIRS criteria to enhance recognition and response time to sepsis.
