One year follow up after implementation of a screening-package for sepsis in an emergency department (original) (raw)
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Initial, successful implementation of sepsis guidelines in an emergency department
Danish medical journal, 2012
Early screening and treatment of sepsis can reduce mortality. Region Zealand established guidelines for the diagnosis and treatment of sepsis. We assess an interdisciplinary intervention for implementation of these guidelines at the Department of Emergency Medicine at Nykøbing Falster Hospital from July 2009 to August 2010. Structured training was imparted to personnel during the first 18 weeks. Electronically accessible guidelines, posters with diagnostic and treatment algorithms, pocket references and checklists were made available to encourage adherence to the guidelines. Key nurses and doctors encouraged compliance. Journal audits (at baseline, 18 weeks and one year) were undertaken to measure adherence to six elements of the sepsis guidelines: lactate measurement, oxygen and fluid treatment, timely antibiotic treatment, blood culture and planning of treatment monitoring. A total of 27 (baseline), 29 (18 weeks) and 48 (one year) patients were included for analysis. Adherence to ...
Poor Compliance with Sepsis Guidelines in a Tertiary Care Children’s Hospital Emergency Room
Frontiers in Pediatrics
Objectives: This study aimed to assess factors related to adherence to the Pediatric Advanced Life Support guidelines for severe sepsis and septic shock in an emergency room (ER) of a tertiary care children's hospital. Methods: This was a retrospective, observational study of children (0-18 years old) in The Children's Hospital of San Antonio ER over 1 year with the International Consensus Definition Codes, version-9 (ICD-9) diagnostic codes for "severe sepsis" and "shocks." Patients in the adherent group were those who met all three elements of adherence: (1) rapid vascular access with at most one IV attempt before seeking alternate access (unless already in place), (2) fluids administered within 15 min from sepsis recognition, and (3) antibiotic administration started within 1 h of sepsis recognition. Comparisons between groups with and without sepsis guideline adherence were performed using Student's t-test (the measurements expressed as median values). The proportions were compared using chi-square test. p-Value ≤0.05 was considered significant. results: A total of 43 patients who visited the ER from July 2014 to July 2015 had clinically proven severe sepsis or SS ICD-9 codes. The median age was 5 years. The median triage time, times from triage to vascular access, fluid administration and antibiotic administration were 26, 48.5, 76, and 135 min, respectively. Adherence to vascular access, fluid, and antibiotic administration guidelines was 21, 26, and 34%, respectively. Appropriate fluid bolus (20 ml/kg over 15-20 min) was only seen in 6% of patients in the non-adherent group versus 38% in the adherent group (p = 0.01). All of the patients in the non-adherent group used an infusion pump for fluid resuscitation. Hypotension and ≥3 organ dysfunction were more commonly observed in patients in adherent group as compared to patients in non-adherent group (38 vs. 14% p = 0.24; 63 vs. 23% p = 0.03). conclusion: Overall adherence to sepsis guidelines was low. The factors associated with non-adherence to sepsis guidelines were >1 attempt at vascular access, delay in antibiotic ordering, fluid administration using infusion pump, absence of hypotension, and absence of three or more organs in dysfunction at ER presentation.
SBMU publishing, 2017
Introduction: Although significant development in the field of medicine is achieved, sepsis is still a major issue threatening humans' lives. This study was aimed to audit the management of severe sepsis and septic shock patients in emergency department (ED) according to the present standard guidelines. Methods: This is a prospective audit on approaching adult septic patients who were admitted to ED. The audit checklist was created based on the protocols of Surviving Sepsis Campaign and British Royal College recommendations. The mean knowledge score and the compliance rate of studied measures regarding standard protocols were calculated using SPSS version 21. Results: 30 emergency medicine residents were audited (63.3% male). The mean knowledge score of studied residents regarding standard guidelines were 5.07 ± 1.78 (IQR = 2) in pre education and 8.17 ± 1.31 (IQR = 85) in post education phase (p < 0.001). There was excellent compliance with standard in 4 (22%) studied measures, good in 2 (11%), fair in 1 (6%), weak in 2 (11%), and poor in 9 (50%). 64% of poor compliance measures correlated to therapeutic factors. After training, score of 5 measures including checking vital signs in < 20 minute, central vein pressure measurement in < 1 hour, blood culture request, administration of vasopressor agents, and high flow O 2 therapy were improved clinically, but not statistically. Conclusion: The protocol adherence in management of severe sepsis and septic shock for urine output measurement, central venous pressure monitoring, administration of inotrope agents, blood transfusion, intravenous antibiotic and hydration therapy, and high flow O 2 delivery were disappointingly low. It seems training workshops and implementation of Clinical audit can improve residents' adherence to current standard guidelines regarding severe sepsis and septic shock.
Journal for Healthcare Quality, 2013
Introduction: Sepsis is recognized as an often-lethal disease. Recommended guidelines are complex and time sensitive. Response teams (RTs) have demonstrated success in implementation of quality initiatives. The purpose of this study was to evaluate variations in noncompliance with recommended sepsis guidelines overall and between a sepsis-focused RT and standard care. Methods: This retrospective chart review categorized septic patients based on treatment by a sepsis response team (SRT) versus standard care (non-SRT). Guideline compliance was based upon the Surviving Sepsis evaluation and treatment guidelines. Results: Patient records for 123 identified septic patients post first-year implementation were evaluated. Overall, compliance rates were low and there were variations in compliance between the treatment providers. The SRT was more compliant than the non-SRT. SRT noncompliance was more often due to failure to achieve therapeutic goals within the recommended time. Mortality benefit was not statistically significant between groups; however mortality was higher in the non-SRT group. Conclusion: Noncompliance is more complex than simple failure to initiate, especially in time-dependent therapies. The development and education of an RT demonstrates improvement in application of sepsis-focused therapies over standard care.
The Use of an Educational Tool to Improve Adjustment to the Sepsis Protocol and the Clinical Impact
Nursing & Care Open Access Journal, 2017
Introduction: Sepsis is a major global health problem and is responsible for the deaths of thousands of people each year. It is the second leading cause of death in intensive care units, after coronary heart disease. Due to the high mortality rate, sepsis needs to be addressed through evidence-based practice, institutionalized protocols, well-developed clinical strategies, and continuing education. This study analyzed the clinical impact of adherence to an education tool for sepsis control measures at the Adventist Hospital of Belém in Brazil. Methodology: A prospective, quasi-experimental study was carried out from March to December 2015. The study included 152 patients diagnosed as having selection criteria with suspected sepsis. The patients diagnosed in the emergency department of the hospital were divided into a control group (n=30) and a case group (n=122) based on the period in which an educational tool was applied, for adherence to the hospital sepsis protocol. Results: The best adherence measure, after the tool application, was antimicrobial therapy. There was a reduction in the hospitalization time of the surviving patients from 19.7 days to 7.7 days and the mortality rate decreased from 63.3% to 30.6%. Conclusion: Although adherence to resuscitation packages was low, the education tool increased the insight of professionals in the identification of septic patients, resulting in a diagnosis and early treatment that corresponded with a reduction in hospitalization time and a decrease in mortality.
Critical Care, 2014
Introduction: Current sepsis guidelines recommend antimicrobial treatment (AT) within one hour after onset of sepsis-related organ dysfunction (OD) and surgical source control within 12 hours. The objective of this study was to explore the association between initial infection management according to sepsis treatment recommendations and patient outcome. Methods: In a prospective observational multi-center cohort study in 44 German ICUs, we studied 1,011 patients with severe sepsis or septic shock regarding times to AT, source control, and adequacy of AT. Primary outcome was 28-day mortality. Results: Median time to AT was 2.1 (IQR 0.8 -6.0) hours and 3 hours (-0.1 -13.7) to surgical source control. Only 370 (36.6%) patients received AT within one hour after OD in compliance with recommendation. Among 422 patients receiving surgical or interventional source control, those who received source control later than 6 hours after onset of OD had a significantly higher 28-day mortality than patients with earlier source control (42.9% versus 26.7%, P <0.001). Time to AT was significantly longer in ICU and hospital non-survivors; no linear relationship was found between time to AT and 28-day mortality. Regardless of timing, 28-day mortality rate was lower in patients with adequate than non-adequate AT (30.3% versus 40.9%, P < 0.001).
Revista Española de Quimioterapia, 2022
Introduction. Sepsis is the main cause of death in hospitals and the implementation of diagnosis and treatment bundles has shown to improve its evolution. However, there is a lack of evidence about patients attended in conventional units. Methods. A 3-year retrospective cohort study was conducted. Patients hospitalized in Internal Medicine units with sepsis were included and assigned to two cohorts according to Sepsis Code (SC) activation (group A) or not (B). Baseline and evolution variables were collected. Results. A total of 653 patients were included. In 296 cases SC was activated. Mean age was 81.43 years, median Charlson comorbidity index (CCI) was 2 and 63.25% showed some functional disability. More bundles were completed in group A: blood cultures 95.2% vs 72.5% (p < 0.001), extended spectrum antibiotics 59.1% vs 41.4% (p < 0.001), fluid resuscitation 96.62% vs 80.95% (p < 0.001). Infection control at 72 hours was quite higher in group A (81.42% vs 55.18%, odds rati...
Improving Care of the Sepsis Patient
The Joint Commission Journal on Quality and Patient Safety, 2008
Background: In 2004, Christiana Care Health System (Christiana Care), a 1,100-bed tertiary care facility, used the Surviving Sepsis Campaign guidelines as the foundation for an independent initiative to reduce the mortality rate by at least 25%. Methods: In 2004, an interdisciplinary sepsis team developed a process for rapidly recognizing at-risk patients; evaluating a patient's clinical status; and providing appropriate, timely therapy in three major areas of sepsis care; recognition of the sepsis patient, resuscitation priorities, and intensive care management. The Sepsis Alert program, which did not require additional staffing, was developed and implemented in 10 months. The Sepsis Alert packet included a care management guideline, a treatment algorithm, an emergency department treatment order set, and multiple adjuncts to streamline patient identification and management. Results: Introduction of sepsis resuscitation and critical care management standards led to a 49.4% decrease in mortality rates (p < .0001), a 34.0% decrease in average length of hospital stay (p < .0002), and a 188.2% increase in the proportion of patients discharged to home (p < .0001) when the historic control group is compared with the postimplementation group from January 2005 through December 2007. Discussion: An integrated leadership team, using existing resources, transformed frontline clinical practice by providers from multiple disciplines to reduce mortality in the population of patients with sepsis.