Improving Sepsis Recognition and Management in the Adult Acute Care Medical Unit
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Abstract
Problem: At a regional hospital, on the adult acute-care medical unit, 83% of the sepsis best practice advisory alerts (BPAs) were cancelled or had no further documentation, leading to delayed recognition of sepsis. Missing documentation of vital signs (VS) and respiratory rates (RR) contributed to inconsistent generation of BPAs. Purpose: The purpose of this Quality Improvement project was to implement a bedside sepsis huddle to improve early recognition of sepsis. Methods: Team members included the project lead (PL), the clinical site representative, the unit clinical director, a unit nurse educator, and 43 staff nurses. Over 15 weeks of implementation, staff nurses were tasked with ensuring VS and RR were documented every four hours. If a BPA was generated, documentation in the sepsis narrator was initiated within one hour followed by a bedside sepsis huddle. Data collection was completed by the PL through chart audits and sepsis reports, with an average of 38 charts audited per week. The primary outcome was the number of patient charts with a BPA generated who had a sepsis huddle initiated. Secondary outcomes were weekly compliance rates for VS and RR documentation. Results were analyzed via a run chart. Results: No BPAs were generated during implementation, although 12 patients were identified as septic by nurses. Of the 12 septic patients, 50% had a bedside sepsis huddle. The baseline compliance rate for VS and RR documentation was 50% and 45% respectively. Following implementation, the median compliance rate for VS and RR documentation was 83% and 77% respectively. Conclusion: Results show education marginally improved compliance rates of VS and RR documentation. In week five, a steep decline in compliance with documentation of VS and RR was observed, which was attributed to the construction of patient rooms on the unit. Currently, no conclusion can be made about the true effectiveness of a sepsis huddle on improving early recognition of sepsis as there is not enough data to make a generalized conclusion. However, a sepsis huddle in conjunction with a computerized early alert system, for the early recognition could be successful if compliance with timely documentation of VS and RR is maintained.