• The Effect of a Sepsis Order Set on Antibiotic Administration

      Carney, Sara E.; Reid, Rachel (2021-05)
      Problem: In 2016 the Surviving Sepsis Campaign updated their clinical practice guidelines to focus on the early detection and management of sepsis. Multiple randomized controlled trials showed with each delayed hour of antibiotic administration, there was an increased mortality rate of 0.5 to 4% among septic patients. Based on this data, the guidelines strongly recommended that intravenous antibiotics be administered within one hour of sepsis diagnosis. In response to the updated guidelines, hospital data was reviewed, and it was found that only 35% of all septic patients were receiving antibiotics within the recommended window of sepsis diagnosis. Purpose: To implement and evaluate the effectiveness of a standardized sepsis protocol/order set in the inpatient medical unit. Methods: A sepsis order set, based off the 2016 Surviving Sepsis Campaign Guidelines, was embedded in the electronic medical record and incorporated as part of the medical unit’s pre-existing Early Warning Signs (EWS) System. Time from sepsis diagnosis to time of antibiotic administration was evaluated weekly during the implementation phase and compared to data from three months prior to the implementation phase. Additional outcomes included provider use of the sepsis order set and 30-day mortality rates. EWS nurses and physician members of the sepsis team assisted providers with identification of septic patients on the unit and implementation of the sepsis order set. Results: The median percentage of patients receiving antibiotics within three hours of sepsis diagnosis increased from 0% (n=24) to 100% (n = 27). The providers utilized the sepsis order set approximately 93% of the time. Thirty-day mortality rates increased from 20% to 26% however were not statistically significant. Conclusions: The implementation of a sepsis order set has shown to increase the percentage of septic patients receiving antibiotics within three hours of sepsis diagnosis. Incorporation of the sepsis order set into a pre-existing EWS protocol may have assisted with noted improvements.
    • Implementing a Deterioration Index Score & Narrator to Improve Sepsis Identification and Management

      Asu, Christelle E.; Gourley, Bridgitte (2022-05)
      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.
    • Utilization of Deterioration Index Model to Improve Sepsis Management in Medical Unit

      Sherpa, Phudorji L.; Gourley, Bridgitte (2022-05)
      Problem and Purpose: One third of inpatient deaths are related to sepsis. In a medical unit, a sample of 245 sepsis patients in 2020, 28.4 % failed timely sepsis treatment and 35.4% lacked blood culture within 3 hours sepsis recognition. The implementation site was a 35-bed adult medical unit where the utilization of the existing sepsis best practice alert (BPA) in the EHR was substandard. From November 2020 to February 2021, unit nurses bypassed or ignored 84% of sepsis BPA. This DNP project sought to improve recognition of early sepsis complications and management in a medical unit by implementing a new EPIC BPA Deterioration Index with Sepsis Score (DISS) and sepsis bundle. Methods: Based on Press Ganey Sepsis Workflow, nursing staff in the unit were provided education and training on sepsis, sepsis bundle, and early identification and management of sepsis. Nurses were also provided training on DISS, which was incorporated into the hospital EPIC system. Measurements included DI BPA encounters, length of stay (LOS), and Blood culture draw compliance. The intervention site was a 35-bed adult medical unit. Results: Blood Cultures in <3 hours improved an average of 30% for the intervention period, and the average monthly length of stay trended down during the intervention. The number of alerts decreased significantly during the intervention period. Conclusion: Machine learning prediction models such as DISS with sepsis bundle can be utilized to identify early sepsis complications and improve timely blood culture compliance, and may lower LOS for patients with sepsis.