Catching the Wave Before it Crashes - Surviving Sepsis in the Emergency Department

2.50
Hdl Handle:
http://hdl.handle.net/10755/162679
Type:
Presentation
Title:
Catching the Wave Before it Crashes - Surviving Sepsis in the Emergency Department
Abstract:
Catching the Wave Before it Crashes - Surviving Sepsis in the Emergency Department
Conference Sponsor:Emergency Nurses Association
Conference Year:2007
Author:Tlockowski, Debbie Sue, RN, A.S.
P.I. Institution Name:Stony Brook University Medical Center
Title:Emergency Department and Transport Team Nurse Educator
Contact Address:Nicolls Rd., Stony Brook, NY, 11794, USA
Contact Telephone:(631) 444-2909
Co-Authors:Eileen Dowdy, RN; Anna Rosenthal, RN, MS
[Clinical Poster] Clinical Topic: Mortality rates associated with severe sepsis remain unacceptably high worldwide. In the United States, sepsis kills more noncoronary intensive care unit patients than any other illness. Studies show that early identification and treatment of the underlying causes of sepsis may improve patient outcomes. In January 2006, a review of patient records at this Level I Trauma Center with 75,000 visits a year revealed staff had missed a number of sepsis cases and inconsistently complied with the first four elements of the Institute for Health Improvement (IHI) Sepsis Resuscitation Bundle. It was imperative that we develop a systematic approach to the early recognition and treatment of patients presenting with sepsis, with specific focus on increasing compliance with the first four elements of the sepsis resuscitation bundle.

Implementation: In May 2006, a multidisciplinary team of emergency department (ED), critical care, and continuous quality improvement (CQI) staff developed an educational campaign targeted to medical and nursing staff to improve recognition of sepsis and initiation of appropriate treatment without delay. Particular attention was paid to the implementation of the first four elements of the resuscitation bundle: serum lactate measured within six hours; blood cultures drawn before antibiotics given; antibiotic compliance (i.e., antibiotic administered within three hours from triage time); fluids and vasopressors given for hypotension (MAP 65 or elevated lactate); and monitoring of central venous pressure (CVP) and central venous oxygen saturation (SCVO2). Changes were made to the existing triage protocol as follows: a sepsis screening tool was added to triage guidelines, so potential sepsis patients with stable signs could be triaged at ESI-Level 2, rather than ESI-Level 3; fever and sepsis laboratory order panels were created to facilitate physician ordering of pertinent lab work, including serum lactate and blood cultures; an ED sepsis order set was developed, modeled after the order set specified in the IHI sepsis resuscitation bundle, which provides guidelines for the administration of specific antibiotic therapy; IV antibiotics were added to the ED Pyxis medication stations, to reduce door-to-antibiotic time; and a STAT lab was created to reduce turnaround time for lab results. All triage-competent staff completed a 4-hour class on the ESI triage system and a one-hour in-service that reviewed the new sepsis screening tool and the sepsis resuscitation bundle. Other in-services addressed sepsis resuscitation bundle order sets, review of CVP monitoring, the importance of measuring lactic acid, and triage to antibiotic time administered. The program was implemented in July 2006, with data evaluation completed in March 2007.

Outcomes: Post-implementation results demonstrate significant improvements in the recognition and prompt treatment of sepsis in the emergency department. An evaluation comparing data for the six-month period immediately before (February 2006 to June 2006; N=34) and immediately after (July 12006 to March 2007; N=126) implementation revealed the following: the mean number of patients treated for sepsis increased from 6.8 to 14 per month; compliance with all four sepsis bundle elements increased from 48% to 71.4%; and hospital-wide sepsis mortality rate per 100 discharges declined from 38.8% to 20%. To sustain these improvements compliance continues to be monitored and feedback provided to individual staff members. Sepsis cases and sepsis patient charts are reviewed at monthly staff meetings and results posted on the QI bulletin board. In addition, nurses continue to be indispensable in orienting new and rotating physicians to the program. An ED critical care flow sheet, created post-implementation, improves compliance with key components of documentation, such as CVP monitoring, MAP, timing of blood cultures drawn, and glucose monitoring, and provides information on the back, regarding the sepsis bundle, sepsis screening tool, and CVP monitoring.

Recommendations: Emergency nurses play a critical role in the early assessment and treatment of sepsis. However, without a systematic approach to guide staff, sepsis patients may be missed and lifesaving therapy delayed or withheld. Educating nurses on the importance of complying with the sepsis resuscitation bundle should be basic practice for every emergency department. Monitoring of compliance and periodic evaluation of relevant tools and processes should be made routine. The hardwiring of needed action into protocol, as our trauma center achieved, ensures that emergency departments are prepared for action when a sepsis patient comes through its doors.
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.titleCatching the Wave Before it Crashes - Surviving Sepsis in the Emergency Departmenten_GB
dc.identifier.urihttp://hdl.handle.net/10755/162679-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Catching the Wave Before it Crashes - Surviving Sepsis 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">2007</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Tlockowski, Debbie Sue, RN, A.S.</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Stony Brook University Medical Center <br/></td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Emergency Department and Transport Team Nurse Educator</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">Nicolls Rd., Stony Brook, NY, 11794, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">(631) 444-2909</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">debbie.tlockowski@stonybrook.edu</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Eileen Dowdy, RN; Anna Rosenthal, RN, MS</td></tr><tr><td colspan="2" class="item-abstract">[Clinical Poster] Clinical Topic: Mortality rates associated with severe sepsis remain unacceptably high worldwide. In the United States, sepsis kills more noncoronary intensive care unit patients than any other illness. Studies show that early identification and treatment of the underlying causes of sepsis may improve patient outcomes. In January 2006, a review of patient records at this Level I Trauma Center with 75,000 visits a year revealed staff had missed a number of sepsis cases and inconsistently complied with the first four elements of the Institute for Health Improvement (IHI) Sepsis Resuscitation Bundle. It was imperative that we develop a systematic approach to the early recognition and treatment of patients presenting with sepsis, with specific focus on increasing compliance with the first four elements of the sepsis resuscitation bundle.<br/><br/>Implementation: In May 2006, a multidisciplinary team of emergency department (ED), critical care, and continuous quality improvement (CQI) staff developed an educational campaign targeted to medical and nursing staff to improve recognition of sepsis and initiation of appropriate treatment without delay. Particular attention was paid to the implementation of the first four elements of the resuscitation bundle: serum lactate measured within six hours; blood cultures drawn before antibiotics given; antibiotic compliance (i.e., antibiotic administered within three hours from triage time); fluids and vasopressors given for hypotension (MAP 65 or elevated lactate); and monitoring of central venous pressure (CVP) and central venous oxygen saturation (SCVO2). Changes were made to the existing triage protocol as follows: a sepsis screening tool was added to triage guidelines, so potential sepsis patients with stable signs could be triaged at ESI-Level 2, rather than ESI-Level 3; fever and sepsis laboratory order panels were created to facilitate physician ordering of pertinent lab work, including serum lactate and blood cultures; an ED sepsis order set was developed, modeled after the order set specified in the IHI sepsis resuscitation bundle, which provides guidelines for the administration of specific antibiotic therapy; IV antibiotics were added to the ED Pyxis medication stations, to reduce door-to-antibiotic time; and a STAT lab was created to reduce turnaround time for lab results. All triage-competent staff completed a 4-hour class on the ESI triage system and a one-hour in-service that reviewed the new sepsis screening tool and the sepsis resuscitation bundle. Other in-services addressed sepsis resuscitation bundle order sets, review of CVP monitoring, the importance of measuring lactic acid, and triage to antibiotic time administered. The program was implemented in July 2006, with data evaluation completed in March 2007.<br/><br/>Outcomes: Post-implementation results demonstrate significant improvements in the recognition and prompt treatment of sepsis in the emergency department. An evaluation comparing data for the six-month period immediately before (February 2006 to June 2006; N=34) and immediately after (July 12006 to March 2007; N=126) implementation revealed the following: the mean number of patients treated for sepsis increased from 6.8 to 14 per month; compliance with all four sepsis bundle elements increased from 48% to 71.4%; and hospital-wide sepsis mortality rate per 100 discharges declined from 38.8% to 20%. To sustain these improvements compliance continues to be monitored and feedback provided to individual staff members. Sepsis cases and sepsis patient charts are reviewed at monthly staff meetings and results posted on the QI bulletin board. In addition, nurses continue to be indispensable in orienting new and rotating physicians to the program. An ED critical care flow sheet, created post-implementation, improves compliance with key components of documentation, such as CVP monitoring, MAP, timing of blood cultures drawn, and glucose monitoring, and provides information on the back, regarding the sepsis bundle, sepsis screening tool, and CVP monitoring.<br/><br/>Recommendations: Emergency nurses play a critical role in the early assessment and treatment of sepsis. However, without a systematic approach to guide staff, sepsis patients may be missed and lifesaving therapy delayed or withheld. Educating nurses on the importance of complying with the sepsis resuscitation bundle should be basic practice for every emergency department. Monitoring of compliance and periodic evaluation of relevant tools and processes should be made routine. The hardwiring of needed action into protocol, as our trauma center achieved, ensures that emergency departments are prepared for action when a sepsis patient comes through its doors.</td></tr></table>en_GB
dc.date.available2011-10-27T10:32:18Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:32:18Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
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