2.50
Hdl Handle:
http://hdl.handle.net/10755/162916
Type:
Presentation
Title:
Severe Sepsis and Sepsis Shock: Combating an International Killer
Abstract:
Severe Sepsis and Sepsis Shock: Combating an International Killer
Conference Sponsor:Emergency Nurses Association
Conference Year:2006
Author:Pyle, Kirsten, RN, CCRN
P.I. Institution Name:Hoag Memorial Hospital Presbyterian
Title:Emergency Department Director
Contact Address:One Hoag Dr., PO Box 6100, Newport Beach, CA, 92658- 6100, USA
Contact Telephone:(949) 764-6870
Co-Authors:Rowena Bernstein, RN, BSN, CEN, MICN; ebra Ermita, RN; Ginger Pierson, RN, MSN, CVCNS, CCRN; Carla Schneider, RN, BSN, MICN; Melinda Jordan, RN, MICN, CEN; Melissa Dover, RN, MICN; Margaret Flanagen, RN, MSN, FNP, MICN; Michelle McMillion, RN, ADN, MICN;
Clinical Topic: Worldwide mortality rates for severe sepsis and septic shock are unacceptably high, and with increased use of invasive procedures in aging and high-risk populations, such as HIV and cancer patients, the numbers are expected to grow. Sepsis kills rapidly, and because its course varies, it is difficult to diagnose and treat; often it is necessary to treat patients at the same time as confirming the diagnosis. To meet the challenge of sepsis, the emergency care unit (ECU) nurses at a community hospital in Orange County, CA, serving 60,000 patients annually, spearheaded a house-wide campaign to implement guidelines of the international Surviving Sepsis Campaign (SSC). Our goal was to elevate sepsis to emergency status, on a par with acute myocardial infarction or acute ischemic stroke, thereby reducing the hospital?s overall sepsis mortality rate by 25% over five years, while improving bed utilization. Implementation: In November 2004, the ECU team gathered data from risk management personnel on historical status of sepsis cases, and from coding staff to help identify needs. This and other information on sepsis definition, recognition, and early goal-directed therapy, along with case studies and outcomes feedback, was presented at a series of educational meetings and at an all-day sepsis conference featuring national speakers to nurses from the ECU, intensive care unit (ICU), critical care unit (CCU), and cardiovascular intensive care unit (CVIC) as well as to physicians, pharmacy staff, case management staff, social service personnel for critical care, laboratory technicians, and coding staff. Using SSC guidelines, the ECU team developed an ECU sepsis protocol and order set; an empiric antimicrobial recommendation table, based on the 2004 antibiogram; and a procedure for ensuring all recommended antimicrobials remain stocked in the Pyxis machine for immediate use. A lab panel for adult sepsis and an ECU outcomes quality tool also was developed. In addition, the definition of "code emergent" triage criteria was revised for severe sepsis, and ECU staff were educated in lung protective strategies in patients requiring mechanical ventilation. Outcomes: Since implementing the initiative, the ECU team has met its goal: As of December 2005, the overall sepsis mortality rate has dropped by 25%. Our revised triage criteria for "code emergent" has resulted in an almost 100% compliance rate, ensuring a triage to physician time of less than 10 minutes. From January 2004 to December 2005, critical care mortality decreased from 20% (n=121) to 15% (n=95) (p = < 0.05), and in-hospital mortality declined from 32.5% to 24.5% (p = < 0.05). Median CC length of stay for patients admitted directly from ECU to CC also declined, from 5.4 days to 2.0 days, and median hospital length of stay decreased from 17.0 days to 7.0 days. The percent of sepsis patients who developed renal dysfunction requiring dialysis was reduced from 14.9% to 9.9% (p = 0.14), and median ventilation days dropped from 8.9 to 5.7. Together, these results have increased critical care bed availability, thereby easing patient flow.
Recommendations: Emergency nurses can choose to be a critical agent for change in the way their facilities manage sepsis patients. A well coordinated and collaborative multidisciplinary effort can yield immediate improvements in care, reduce mortality rates, and increase bed availability by decreasing CCU and hospital lengths of stay.
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.titleSevere Sepsis and Sepsis Shock: Combating an International Killeren_GB
dc.identifier.urihttp://hdl.handle.net/10755/162916-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Severe Sepsis and Sepsis Shock: Combating an International Killer</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">2006</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Pyle, Kirsten, RN, CCRN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Hoag Memorial Hospital Presbyterian</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Emergency Department Director</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">One Hoag Dr., PO Box 6100, Newport Beach, CA, 92658- 6100, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">(949) 764-6870</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">kirsten.pyle@hoaghospital.org</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Rowena Bernstein, RN, BSN, CEN, MICN; ebra Ermita, RN; Ginger Pierson, RN, MSN, CVCNS, CCRN; Carla Schneider, RN, BSN, MICN; Melinda Jordan, RN, MICN, CEN; Melissa Dover, RN, MICN; Margaret Flanagen, RN, MSN, FNP, MICN; Michelle McMillion, RN, ADN, MICN; </td></tr><tr><td colspan="2" class="item-abstract">Clinical Topic: Worldwide mortality rates for severe sepsis and septic shock are unacceptably high, and with increased use of invasive procedures in aging and high-risk populations, such as HIV and cancer patients, the numbers are expected to grow. Sepsis kills rapidly, and because its course varies, it is difficult to diagnose and treat; often it is necessary to treat patients at the same time as confirming the diagnosis. To meet the challenge of sepsis, the emergency care unit (ECU) nurses at a community hospital in Orange County, CA, serving 60,000 patients annually, spearheaded a house-wide campaign to implement guidelines of the international Surviving Sepsis Campaign (SSC). Our goal was to elevate sepsis to emergency status, on a par with acute myocardial infarction or acute ischemic stroke, thereby reducing the hospital?s overall sepsis mortality rate by 25% over five years, while improving bed utilization. Implementation: In November 2004, the ECU team gathered data from risk management personnel on historical status of sepsis cases, and from coding staff to help identify needs. This and other information on sepsis definition, recognition, and early goal-directed therapy, along with case studies and outcomes feedback, was presented at a series of educational meetings and at an all-day sepsis conference featuring national speakers to nurses from the ECU, intensive care unit (ICU), critical care unit (CCU), and cardiovascular intensive care unit (CVIC) as well as to physicians, pharmacy staff, case management staff, social service personnel for critical care, laboratory technicians, and coding staff. Using SSC guidelines, the ECU team developed an ECU sepsis protocol and order set; an empiric antimicrobial recommendation table, based on the 2004 antibiogram; and a procedure for ensuring all recommended antimicrobials remain stocked in the Pyxis machine for immediate use. A lab panel for adult sepsis and an ECU outcomes quality tool also was developed. In addition, the definition of &quot;code emergent&quot; triage criteria was revised for severe sepsis, and ECU staff were educated in lung protective strategies in patients requiring mechanical ventilation. Outcomes: Since implementing the initiative, the ECU team has met its goal: As of December 2005, the overall sepsis mortality rate has dropped by 25%. Our revised triage criteria for &quot;code emergent&quot; has resulted in an almost 100% compliance rate, ensuring a triage to physician time of less than 10 minutes. From January 2004 to December 2005, critical care mortality decreased from 20% (n=121) to 15% (n=95) (p = &lt; 0.05), and in-hospital mortality declined from 32.5% to 24.5% (p = &lt; 0.05). Median CC length of stay for patients admitted directly from ECU to CC also declined, from 5.4 days to 2.0 days, and median hospital length of stay decreased from 17.0 days to 7.0 days. The percent of sepsis patients who developed renal dysfunction requiring dialysis was reduced from 14.9% to 9.9% (p = 0.14), and median ventilation days dropped from 8.9 to 5.7. Together, these results have increased critical care bed availability, thereby easing patient flow. <br/>Recommendations: Emergency nurses can choose to be a critical agent for change in the way their facilities manage sepsis patients. A well coordinated and collaborative multidisciplinary effort can yield immediate improvements in care, reduce mortality rates, and increase bed availability by decreasing CCU and hospital lengths of stay.</td></tr></table>en_GB
dc.date.available2011-10-27T10:36:21Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:36:21Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
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