2.50
Hdl Handle:
http://hdl.handle.net/10755/162378
Type:
Presentation
Title:
Implementing a Nurse Driven Sepsis Protocol in the Emergency Department
Abstract:
Implementing a Nurse Driven Sepsis Protocol in the Emergency Department
Conference Sponsor:Emergency Nurses Association
Conference Year:2010
Author:Fowle, Elizabeth S., RN, BA, BSN, CEN
P.I. Institution Name:WakeMed -Adult Emergency Department
Title:Staff Nurse, Adult Emergency Department
Contact Address:3000 New Bern Avenue, Raleigh, NC, 27610, USA
Contact Telephone:919-350-5805
Co-Authors:Bettielou Conerly, RN, BSN, CCRN, CNRN, BC
[ENA Annual Conference - Evidence-based Practice Presentation]
Purpose: Sepsis is an overwhelming inflammatory disease process that challenges the immune system and can range in severity from uncomplicated (not requiring hospitalization) to severe sepsis (involving vital organs) to septic shock (multiple organs are involved, resulting in hypotension and impaired oxygen delivery to the body). Severe sepsis has a mortality rate of 30-50% with septic shock rising to 50-60%. Early identification and treatment of sepsis is critical in improving patient outcomes.

Design: Because sepsis is often difficult to identify, a mandatory screening tool was incorporated into the triage section of the computer charting program that walks the nurse through various questions and then identifies if the patient meets inclusion criteria for possible sepsis.

Setting: A Southeastern Emergency Department with Level 1 Trauma designation that treats greater than 142,000 patients/year.

Participants/Subjects: This nurse driven process being utilized screens 100% of all patients presenting to the Adult ED.

Methods: To meet the inclusion criteria, there must be a suspicion of infection and two or more of the following: Temperature equal to or greater than 38 degrees C or < 36 degrees C, Heart Rate > 90 bpm, Respiratory Rate > 20/min (or Mechanical Ventilation), and Altered Mental Status. A standing order set then provides for lab work, including a venous lactate. These orders also provide for initial crystalloid IV fluid resuscitation if warranted. All of these orders are implemented prior to the patient being seen by the physician. This initial screening and treatment provides the springboard into a protocol initiated by the physician if the patient then meets criteria for severe sepsis. In this protocol, a special central venous catheter is inserted to provide ScVO2 and CVP monitoring. This gives data needed to provide Early Goal Directed Therapy (EGDT) outlined in the protocol for severe sepsis resuscitation.

Results/Outcomes: Initially, the rollout of the sepsis protocol met with resistance from nurses because it coincided with a restructuring of the work place and a shift to team nursing. After that transition, staff nurses were more open to this protocol. It required training classes to teach the protocol and also instruct about the screening, catheters, and monitoring required. This was done with the program implementation and is repeated for all new staff nurses. The monitoring piece is incorporated in the mandatory annual skills testing. By making the screening tool a mandatory question, it quickly became incorporated in the body of triage questions, insuring that 100% of patients presenting to the ED are screened. 4.1 patients each week are identified with a primary or secondary diagnosis of severe sepsis, though dozens meet screening criteria for sepsis.

Implications: Emergency Departments, regardless of size, should implement a protocol to identify and provide early treatment of septic patients. Developing a nurse driven identification system in triage is critical to the success of the program. A standing order set is also important to begin early treatment. This is crucial because time is of the essence and many Emergency Departments grapple with prolonged wait times and gridlock.
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.titleImplementing a Nurse Driven Sepsis Protocol in the Emergency Departmenten_GB
dc.identifier.urihttp://hdl.handle.net/10755/162378-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Implementing a Nurse Driven Sepsis Protocol in the Emergency Department</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">Fowle, Elizabeth S., RN, BA, BSN, CEN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">WakeMed -Adult Emergency Department</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Staff Nurse, Adult Emergency Department</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">3000 New Bern Avenue, Raleigh, NC, 27610, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">919-350-5805</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">efowle@wakemed.org</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Bettielou Conerly, RN, BSN, CCRN, CNRN, BC</td></tr><tr><td colspan="2" class="item-abstract">[ENA Annual Conference - Evidence-based Practice Presentation] <br/>Purpose: Sepsis is an overwhelming inflammatory disease process that challenges the immune system and can range in severity from uncomplicated (not requiring hospitalization) to severe sepsis (involving vital organs) to septic shock (multiple organs are involved, resulting in hypotension and impaired oxygen delivery to the body). Severe sepsis has a mortality rate of 30-50% with septic shock rising to 50-60%. Early identification and treatment of sepsis is critical in improving patient outcomes. <br/><br/>Design: Because sepsis is often difficult to identify, a mandatory screening tool was incorporated into the triage section of the computer charting program that walks the nurse through various questions and then identifies if the patient meets inclusion criteria for possible sepsis. <br/><br/>Setting: A Southeastern Emergency Department with Level 1 Trauma designation that treats greater than 142,000 patients/year.<br/><br/>Participants/Subjects: This nurse driven process being utilized screens 100% of all patients presenting to the Adult ED.<br/><br/>Methods: To meet the inclusion criteria, there must be a suspicion of infection and two or more of the following: Temperature equal to or greater than 38 degrees C or &lt; 36 degrees C, Heart Rate &gt; 90 bpm, Respiratory Rate &gt; 20/min (or Mechanical Ventilation), and Altered Mental Status. A standing order set then provides for lab work, including a venous lactate. These orders also provide for initial crystalloid IV fluid resuscitation if warranted. All of these orders are implemented prior to the patient being seen by the physician. This initial screening and treatment provides the springboard into a protocol initiated by the physician if the patient then meets criteria for severe sepsis. In this protocol, a special central venous catheter is inserted to provide ScVO2 and CVP monitoring. This gives data needed to provide Early Goal Directed Therapy (EGDT) outlined in the protocol for severe sepsis resuscitation.<br/><br/>Results/Outcomes: Initially, the rollout of the sepsis protocol met with resistance from nurses because it coincided with a restructuring of the work place and a shift to team nursing. After that transition, staff nurses were more open to this protocol. It required training classes to teach the protocol and also instruct about the screening, catheters, and monitoring required. This was done with the program implementation and is repeated for all new staff nurses. The monitoring piece is incorporated in the mandatory annual skills testing. By making the screening tool a mandatory question, it quickly became incorporated in the body of triage questions, insuring that 100% of patients presenting to the ED are screened. 4.1 patients each week are identified with a primary or secondary diagnosis of severe sepsis, though dozens meet screening criteria for sepsis.<br/><br/>Implications: Emergency Departments, regardless of size, should implement a protocol to identify and provide early treatment of septic patients. Developing a nurse driven identification system in triage is critical to the success of the program. A standing order set is also important to begin early treatment. This is crucial because time is of the essence and many Emergency Departments grapple with prolonged wait times and gridlock.<br/></td></tr></table>en_GB
dc.date.available2011-10-27T10:27:10Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:27:10Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
All Items in this repository are protected by copyright, with all rights reserved, unless otherwise indicated.