2.50
Hdl Handle:
http://hdl.handle.net/10755/162376
Type:
Presentation
Title:
Think Sepsis: The Implementation of an Adult ED Electronic Screening Protocol
Abstract:
Think Sepsis: The Implementation of an Adult ED Electronic Screening Protocol
Conference Sponsor:Emergency Nurses Association
Conference Year:2010
Author:Evangelista, Estrella, RN, DNP, BSN, MEd, CNL
P.I. Institution Name:Touro University Nevada
Title:ED Nurse
Contact Address:874 American Pacific Drive, Henderson, NV, 89014, USA
Contact Telephone:702-301-9546
[ENA Annual Conference - Evidence-based Practice Presentation]

Purpose: Sepsis is a time sensitive ischemic event that when the narrow window of opportunity is missed, outcomes could be fatal. Severe sepsis mortality (60%) now exceeds AMI and stroke, its incidence increasing at an alarming rate. Literature is limited to outcomes of Early Goal Directed Therapy (EGDT) use and screening of patients in critical care. Wang, (2007) states that more than 69% of ED patients present with signs/symptoms that meet sepsis criteria. Problems with timely and accurate identification of sepsis in the ED exist (Nguyen, et. al, 2006). There is a need to characterize sepsis patients presenting in the ED. The purpose of this project was to: implement a nurse triggered ED sepsis screening protocol and determine the association of the protocol to sepsis outcomes (mortality, cost and length of stay).

Design: Descriptive analysis was used to determine the association between the screening protocol and sepsis outcomes. Data from discharged patients diagnosed with sepsis, severe sepsis and septic shock was queried, abstracted and reviewed retrospectively.

Setting: Adult ED in an urban teaching county hospital.

Subjects: IRB approval was obtained. There were 644 sepsis cases discharged from the hospital (10/07 -10/08). The mean age for sepsis cases was 56 years old, 61.4% males and 38.7% females.

Methodology: The Iowa EBP model was the framework for this quality improvement project. Baseline data was presented to stakeholders. A sepsis multidisciplinary team reviewed evidence, and collaborated to create an electronic sepsis screening tool and a triage decision making tree. To ensure compliance, staff received a 2-hour education workshop. Focus was on rapid identification/triaging of patients who met sepsis criteria (infection plus SIRS), epidemiology, monitoring, documentation and EGDT bundle initiation after diagnosis of sepsis, severe sepsis or septic shock is made. Hospital wide marketing included a webpage, booster education sessions and conferences.

Results: 18,025 patients were admitted to the hospital through the ED, 22%, (3971) presented with SIRS; screening compliance was 95% for SIRS cases. Over the study period, 98% of the 644 discharged sepsis cases were screened in the ED and ED physician order set use was 99.9%; 60% of the hospital discharged sepsis cases were diagnosed upon presentation in the ED and 40% developed sepsis during the hospital stay. Screening decreased mortality from 62% (N=235 baseline) to 27 % (N=644), length of stay from 20.4 to 14 days and cost from $194,000 to $150,000 a year after implementation.

Implications: Active participation empowered nurses to work collaboratively with other ED providers to trigger the EBP innovation. The ED sepsis protocol resulted to a significant positive effect on sepsis outcomes. The inclusion of sepsis patients in screening allowed providers to initiate therapy preventing rapid deterioration and progression of the disease. The use of an EBP framework, transparency of data, consistent staff feedback and re-education is crucial to sustainability. Since 40% of cases developed sepsis during their hospital stay, screening for sepsis hospital wide using the same criteria is recommended.


Repository Posting Date:
27-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Emergency Nurses Association

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleThink Sepsis: The Implementation of an Adult ED Electronic Screening Protocolen_GB
dc.identifier.urihttp://hdl.handle.net/10755/162376-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Think Sepsis: The Implementation of an Adult ED Electronic Screening Protocol</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Emergency Nurses Association</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2010</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Evangelista, Estrella, RN, DNP, BSN, MEd, CNL</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Touro University Nevada</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">ED Nurse</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">874 American Pacific Drive, Henderson, NV, 89014, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">702-301-9546</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">strelhoffman@aol.com</td></tr><tr><td colspan="2" class="item-abstract">[ENA Annual Conference - Evidence-based Practice Presentation] <br/><br/>Purpose: Sepsis is a time sensitive ischemic event that when the narrow window of opportunity is missed, outcomes could be fatal. Severe sepsis mortality (60%) now exceeds AMI and stroke, its incidence increasing at an alarming rate. Literature is limited to outcomes of Early Goal Directed Therapy (EGDT) use and screening of patients in critical care. Wang, (2007) states that more than 69% of ED patients present with signs/symptoms that meet sepsis criteria. Problems with timely and accurate identification of sepsis in the ED exist (Nguyen, et. al, 2006). There is a need to characterize sepsis patients presenting in the ED. The purpose of this project was to: implement a nurse triggered ED sepsis screening protocol and determine the association of the protocol to sepsis outcomes (mortality, cost and length of stay).<br/><br/>Design: Descriptive analysis was used to determine the association between the screening protocol and sepsis outcomes. Data from discharged patients diagnosed with sepsis, severe sepsis and septic shock was queried, abstracted and reviewed retrospectively.<br/><br/>Setting: Adult ED in an urban teaching county hospital. <br/><br/>Subjects: IRB approval was obtained. There were 644 sepsis cases discharged from the hospital (10/07 -10/08). The mean age for sepsis cases was 56 years old, 61.4% males and 38.7% females. <br/><br/>Methodology: The Iowa EBP model was the framework for this quality improvement project. Baseline data was presented to stakeholders. A sepsis multidisciplinary team reviewed evidence, and collaborated to create an electronic sepsis screening tool and a triage decision making tree. To ensure compliance, staff received a 2-hour education workshop. Focus was on rapid identification/triaging of patients who met sepsis criteria (infection plus SIRS), epidemiology, monitoring, documentation and EGDT bundle initiation after diagnosis of sepsis, severe sepsis or septic shock is made. Hospital wide marketing included a webpage, booster education sessions and conferences. <br/><br/>Results: 18,025 patients were admitted to the hospital through the ED, 22%, (3971) presented with SIRS; screening compliance was 95% for SIRS cases. Over the study period, 98% of the 644 discharged sepsis cases were screened in the ED and ED physician order set use was 99.9%; 60% of the hospital discharged sepsis cases were diagnosed upon presentation in the ED and 40% developed sepsis during the hospital stay. Screening decreased mortality from 62% (N=235 baseline) to 27 % (N=644), length of stay from 20.4 to 14 days and cost from $194,000 to $150,000 a year after implementation.<br/><br/>Implications: Active participation empowered nurses to work collaboratively with other ED providers to trigger the EBP innovation. The ED sepsis protocol resulted to a significant positive effect on sepsis outcomes. The inclusion of sepsis patients in screening allowed providers to initiate therapy preventing rapid deterioration and progression of the disease. The use of an EBP framework, transparency of data, consistent staff feedback and re-education is crucial to sustainability. Since 40% of cases developed sepsis during their hospital stay, screening for sepsis hospital wide using the same criteria is recommended.<br/><br/> <br/></td></tr></table>en_GB
dc.date.available2011-10-27T10:27:08Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:27:08Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
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