2.50
Hdl Handle:
http://hdl.handle.net/10755/306559
Category:
Abstract
Type:
Poster
Title:
Infection Connection: Sepsis Screening Tool at Time of Triage
Author(s):
Schanne, Linda C.
Lead Author STTI Affiliation:
Non-member
Author Details:
Linda C. Schanne, MSN, RN, CEN, CCRN, schannel@mlhs.org
Abstract:

Evidence-based Practice Abstract

Purpose: Sepsis is a complex syndrome that is difficult to define, diagnose, and treat especially in the Emergency Department(ED). In the United States, there are 750,000 of severe sepsis cases each year and approximately 25 – 50% of these cases die. ED staff must be able to quickly identify the signs and symptoms of sepsis at time of triage to halt its progression. In this ED, quality improvement results revealed inconsistencies in care and management of septic patients with high mortality rates. The purpose of this evidence-based project was to reduce the sepsis mortality rate in adult patients presenting to the ED.

Design: Retrospective quality improvement sampling was conducted over a one year to determine sepsis mortality rates. A review of the literature was conducted to seek evidence based practices for severe sepsis. A multidisciplinary sepsis team was formed to review the quality improvement findings, examine current practice, review evidence based practices and design a severe sepsis screening process at time of triage and standardize treatment and antibiotic orders.

Setting: Suburban, teaching community hospital with more than 47,000 adult and pediatric patients is seen annually in the ED.

Participants/Subjects: All adult patients over the age of 18 who presented to the ED over a three month period were screened for severe sepsis at time of triage.

Methods: A multidisciplinary sepsis team developed an adult severe sepsis resuscitation bundle for the ED at time of triage The severe sepsis bundle included vital signs screening tool at time of triage, severe sepsis treatment orders and antibiotic guidelines. If vital sign parameters were not met, the triage nurse would notify the physician for evaluation and consider activating a sepsis alert to initiate the treatment orders. The goal of the sepsis alert was to ensure the first antibiotic was administered within one hour and transfer to the intensive care unit in six hours. Monthly quality metrics were evaluated for five months after implementation including the number of sepsis alerts, serum lactate levels and sepsis mortality rates. Based on the number of “false sepsis alerts” after only evaluating triage vital signs, it was decided to revise the sepsis bundle activating the sepsis alert after lactate levels resulted, or failure to resuscitate with intravenous fluids or at physician discretion.

Results/Outcomes: Prior to implementation of the sepsis bundle, the mortality rate for sepsis was 22%. Three months after the revised sepsis bundle was instituted, the mortality rate was reduced to an average of 12.3%.

Implications: Implementation of the severe sepsis bundle at time of triage was successful in decreasing sepsis mortality rates. Sepsis mortality rates dropped after implementing the initial sepsis bundle, but the revised sepsis bundle was more accurate in identifying the truly septic patient. The sepsis team plans on meeting quarterly to monitor and drill-down on all sepsis alerts, lactate levels and mortality cases. Introduction of a non-invasive cardiac output monitor into the sepsis protocol is planned to further optimize fluid resuscitation as well as hospital-wide education on identification and treatment of severe sepsis.

Keywords:
Sepsis Screening Tool
Repository Posting Date:
9-Dec-2013
Date of Publication:
9-Dec-2013
Conference Date:
2013
Conference Name:
2013 ENA Leadership Conference
Conference Host:
Emergency Nurses Association
Conference Location:
Ft. Lauderdale, Florida, USA
Description:
2013 ENA Leadership Conference Theme: Shape the Future. Held at the Greater Fort Lauderdale Broward County Convention Center
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission.

Full metadata record

DC FieldValue Language
dc.language.isoen_USen_GB
dc.type.categoryAbstracten_GB
dc.typePosteren_GB
dc.titleInfection Connection: Sepsis Screening Tool at Time of Triageen_GB
dc.contributor.authorSchanne, Linda C.en_GB
dc.contributor.departmentNon-memberen_GB
dc.author.detailsLinda C. Schanne, MSN, RN, CEN, CCRN, schannel@mlhs.orgen_GB
dc.identifier.urihttp://hdl.handle.net/10755/306559-
dc.description.abstract<p>Evidence-based Practice Abstract<p></p>Purpose: Sepsis is a complex syndrome that is difficult to define, diagnose, and treat especially in the Emergency Department(ED). In the United States, there are 750,000 of severe sepsis cases each year and approximately 25 – 50% of these cases die. ED staff must be able to quickly identify the signs and symptoms of sepsis at time of triage to halt its progression. In this ED, quality improvement results revealed inconsistencies in care and management of septic patients with high mortality rates. The purpose of this evidence-based project was to reduce the sepsis mortality rate in adult patients presenting to the ED.<p></p>Design: Retrospective quality improvement sampling was conducted over a one year to determine sepsis mortality rates. A review of the literature was conducted to seek evidence based practices for severe sepsis. A multidisciplinary sepsis team was formed to review the quality improvement findings, examine current practice, review evidence based practices and design a severe sepsis screening process at time of triage and standardize treatment and antibiotic orders.<p></p>Setting: Suburban, teaching community hospital with more than 47,000 adult and pediatric patients is seen annually in the ED.<p></p>Participants/Subjects: All adult patients over the age of 18 who presented to the ED over a three month period were screened for severe sepsis at time of triage.<p></p>Methods: A multidisciplinary sepsis team developed an adult severe sepsis resuscitation bundle for the ED at time of triage The severe sepsis bundle included vital signs screening tool at time of triage, severe sepsis treatment orders and antibiotic guidelines. If vital sign parameters were not met, the triage nurse would notify the physician for evaluation and consider activating a sepsis alert to initiate the treatment orders. The goal of the sepsis alert was to ensure the first antibiotic was administered within one hour and transfer to the intensive care unit in six hours. Monthly quality metrics were evaluated for five months after implementation including the number of sepsis alerts, serum lactate levels and sepsis mortality rates. Based on the number of “false sepsis alerts” after only evaluating triage vital signs, it was decided to revise the sepsis bundle activating the sepsis alert after lactate levels resulted, or failure to resuscitate with intravenous fluids or at physician discretion.<p></p>Results/Outcomes: Prior to implementation of the sepsis bundle, the mortality rate for sepsis was 22%. Three months after the revised sepsis bundle was instituted, the mortality rate was reduced to an average of 12.3%.<p></p>Implications: Implementation of the severe sepsis bundle at time of triage was successful in decreasing sepsis mortality rates. Sepsis mortality rates dropped after implementing the initial sepsis bundle, but the revised sepsis bundle was more accurate in identifying the truly septic patient. The sepsis team plans on meeting quarterly to monitor and drill-down on all sepsis alerts, lactate levels and mortality cases. Introduction of a non-invasive cardiac output monitor into the sepsis protocol is planned to further optimize fluid resuscitation as well as hospital-wide education on identification and treatment of severe sepsis.</p>en_GB
dc.subjectSepsis Screening Toolen_GB
dc.date.available2013-12-09T16:59:46Z-
dc.date.issued2013-12-09-
dc.date.accessioned2013-12-09T16:59:46Z-
dc.conference.date2013en_GB
dc.conference.name2013 ENA Leadership Conferenceen_GB
dc.conference.hostEmergency Nurses Associationen_GB
dc.conference.locationFt. Lauderdale, Florida, USAen_GB
dc.description2013 ENA Leadership Conference Theme: Shape the Future. Held at the Greater Fort Lauderdale Broward County Convention Centeren_GB
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission.en_GB
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