Implementing a Deterioration Index Score & Narrator to Improve Sepsis Identification and Management

Abstract

Problem: Approximately 35% of deaths in hospitals are related to sepsis, a commonly preventable condition. In a medical-surgical unit at a regional hospital, the risk for sepsis alert fired about 902 times per month between July and December of 2020. Of those alerts, 83% were accepted without further documented action taken by nurses. Lack of action for high sepsis warning alerts resulted in delayed recognition of sepsis and poor patient outcomes. Purpose: The purpose of this quality improvement project was to improve early identification and management of sepsis by developing a standardized process for nurses to use in response to sepsis alerts. Methods: A sepsis workgroup developed a new alert based on the Epic Deterioration Index and Sepsis Scores. The intervention consisted of a screening tool that generates a sepsis alert for nurses in the electronic medical record once criteria are met. A sepsis treatment-bundle tasks list which follows an evidence-based algorithm then guides the nurse through recommended interventions to better monitor adherence and outcomes. The nurses on the unit received training on the new alert and sepsis narrator. Nurses received the alert once the deterioration index reached 60%. Collected data included length of stay for sepsis patients and time to antibiotic administration. Control charts and run charts were used to examine the outcomes. Results: The deterioration index and sepsis treatment guide positively impacted patient outcomes. The length of stay for sepsis patients decreased by an average of 4.9 days following the intervention. The percent of patients receiving antibiotics within the recommended 3 hours of identification increased by 33%. Conclusion: Sepsis can cause poor patient outcomes, decreased quality of life, and mortalities for hospitalized patients. The deterioration index score and sepsis treatment bundle guide are beneficial in assisting nurses with clinical decision-making and earlier treatment of sepsis.