Reducing Sepsis Mortality: Emergency Department and Critical Care Nurses Collaborating

2.50
Hdl Handle:
http://hdl.handle.net/10755/162393
Type:
Presentation
Title:
Reducing Sepsis Mortality: Emergency Department and Critical Care Nurses Collaborating
Abstract:
Reducing Sepsis Mortality: Emergency Department and
Critical Care Nurses Collaborating
Conference Sponsor:Emergency Nurses Association
Conference Year:2010
Author:Miller, Bobbie Jo, RN, MSN, CEN
P.I. Institution Name:Nebraska Methodist Health System
Title:Emergency Department Clinical Nurse Educator
Contact Address:8303 Dodge Street, Omaha, NE, 68114, USA
Contact Telephone:402-354-4430
Co-Authors:Terri D. Perry, RN, BSN; Lilia L. Hansen, RN, BSN; Lori Groves, RN, BSN; Jackie Thielen, RN, APRN-NP, MSN; Vickie Dolan, RN, APRN-NP, APRN-CNS, MSN
[ENA Annual Conference - Evidence-based Practice Presentation]
Purpose: Severe sepsis and septic shock patients are frequently seen in the emergency department (ED) and result with reported mortality rates of 30-50%. Early identification and rapid implementation of bundled, evidence based interventions have been proven to decrease mortality when consistently initiated. Implementation of a screening process and rapid initiation of time sensitive interventions required changes in staff approach and development of new and novel tools to ensure compliance. Leadership strategies include active engagement of staff nurses and development of screening and hand-off tools to systematically prompt implementing advised interventions and facilitate continuity of care. Ongoing surveillance strategies with feedback to staff were required to accomplish a mortality reduction.

Design: This performance improvement data analysis initiative was developed and implemented using evidence based practice guidelines from the Surviving Sepsis Campaign (SSC). Partnering with a Critical Care Redesign Team and the Performance Improvement Model of Plan, Do, Study, Act guided implementation of small tests of change and collaboration between care providers and departments. Ongoing measurement of outcomes and processes guided the actions to overall decrease mortality.

Setting: The setting is a 350 bed community hospital with a 12 bed ED in the Midwest.

Participants/Subjects: Data analysis criteria were collected on adult subjects that were diagnosed with severe sepsis or septic shock in the ED from 2007 through 2009.

Methods: A Sepsis Steering Committee with physician and nursing representation from ED, critical care, pharmacy, and respiratory therapy was initiated in 2007, to adopt SSC bundle elements. All ED personnel were encouraged by ED leadership and staff champions to implement bundle elements to improve patient outcomes. A sepsis screening tool was developed for nurses to launch in triage, collecting more evidence for a severe sepsis diagnosis throughout their ED stay. The tool includes a Severe Sepsis/Septic Shock Checklist that includes all six bundle elements and continued with the patient upon admission. The checklist is an effective communication device informing nurses as to the completed treatments and the treatments yet needed. The data analysis component was used to compare the mortality of patients before and after implementing the bundles. The ED leadership team receives data summaries on each bundle element sharing the information with the ED team, while reinforcing the importance of early identification and early treatment of septic patients.

Results/Outcomes: By implementing the Severe Sepsis Screening Tool and Bundle, ED is recognizing these patients sooner; therefore, initiating treatments sooner which led to decreasing the overall mortality rate. The mortality rate has decreased from 19% to 12% over two years in 297 patients treated.

Implications: Since implementing the Severe Sepsis Bundle, ED is detecting severely septic patients sooner and implementing life saving interventions: intravenous fluids, timely antibiotics, and appropriate placement to critical care units. The recommendation is for ED leadership teams to collaborate with critical care teams to analyze sepsis data creating additional actions needed to further decrease mortality. Future recommendations include collecting and analyzing current septic patient data including mortality rates, adopting and implementing SSC guidelines, then reevaluating mortality rates to determine success.
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.titleReducing Sepsis Mortality: Emergency Department and Critical Care Nurses Collaboratingen_GB
dc.identifier.urihttp://hdl.handle.net/10755/162393-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Reducing Sepsis Mortality: Emergency Department and <br/>Critical Care Nurses Collaborating<br/></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">Miller, Bobbie Jo, RN, MSN, CEN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Nebraska Methodist Health System</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Emergency Department Clinical Nurse Educator</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">8303 Dodge Street, Omaha, NE, 68114, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">402-354-4430</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">bobbiejo.miller@nmhs.org</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Terri D. Perry, RN, BSN; Lilia L. Hansen, RN, BSN; Lori Groves, RN, BSN; Jackie Thielen, RN, APRN-NP, MSN; Vickie Dolan, RN, APRN-NP, APRN-CNS, MSN</td></tr><tr><td colspan="2" class="item-abstract">[ENA Annual Conference - Evidence-based Practice Presentation] <br/>Purpose: Severe sepsis and septic shock patients are frequently seen in the emergency department (ED) and result with reported mortality rates of 30-50%. Early identification and rapid implementation of bundled, evidence based interventions have been proven to decrease mortality when consistently initiated. Implementation of a screening process and rapid initiation of time sensitive interventions required changes in staff approach and development of new and novel tools to ensure compliance. Leadership strategies include active engagement of staff nurses and development of screening and hand-off tools to systematically prompt implementing advised interventions and facilitate continuity of care. Ongoing surveillance strategies with feedback to staff were required to accomplish a mortality reduction. <br/><br/>Design: This performance improvement data analysis initiative was developed and implemented using evidence based practice guidelines from the Surviving Sepsis Campaign (SSC). Partnering with a Critical Care Redesign Team and the Performance Improvement Model of Plan, Do, Study, Act guided implementation of small tests of change and collaboration between care providers and departments. Ongoing measurement of outcomes and processes guided the actions to overall decrease mortality. <br/><br/>Setting: The setting is a 350 bed community hospital with a 12 bed ED in the Midwest.<br/><br/>Participants/Subjects: Data analysis criteria were collected on adult subjects that were diagnosed with severe sepsis or septic shock in the ED from 2007 through 2009.<br/><br/>Methods: A Sepsis Steering Committee with physician and nursing representation from ED, critical care, pharmacy, and respiratory therapy was initiated in 2007, to adopt SSC bundle elements. All ED personnel were encouraged by ED leadership and staff champions to implement bundle elements to improve patient outcomes. A sepsis screening tool was developed for nurses to launch in triage, collecting more evidence for a severe sepsis diagnosis throughout their ED stay. The tool includes a Severe Sepsis/Septic Shock Checklist that includes all six bundle elements and continued with the patient upon admission. The checklist is an effective communication device informing nurses as to the completed treatments and the treatments yet needed. The data analysis component was used to compare the mortality of patients before and after implementing the bundles. The ED leadership team receives data summaries on each bundle element sharing the information with the ED team, while reinforcing the importance of early identification and early treatment of septic patients. <br/><br/>Results/Outcomes: By implementing the Severe Sepsis Screening Tool and Bundle, ED is recognizing these patients sooner; therefore, initiating treatments sooner which led to decreasing the overall mortality rate. The mortality rate has decreased from 19% to 12% over two years in 297 patients treated.<br/><br/>Implications: Since implementing the Severe Sepsis Bundle, ED is detecting severely septic patients sooner and implementing life saving interventions: intravenous fluids, timely antibiotics, and appropriate placement to critical care units. The recommendation is for ED leadership teams to collaborate with critical care teams to analyze sepsis data creating additional actions needed to further decrease mortality. Future recommendations include collecting and analyzing current septic patient data including mortality rates, adopting and implementing SSC guidelines, then reevaluating mortality rates to determine success.<br/></td></tr></table>en_GB
dc.date.available2011-10-27T10:27:26Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:27:26Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
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