2.50
Hdl Handle:
http://hdl.handle.net/10755/306609
Category:
Abstract
Type:
Poster
Title:
Making a Difference at Triage: Screening Everyone for Sepsis
Author(s):
Kane, Joanne; Robin, Nancy M.; Brennan, Denise
Lead Author STTI Affiliation:
Non-member
Author Details:
Joanne Kane, RN, CEN, jodoh20@yahoo.com; Nancy M. Robin, MEd, RN, CEN; Denise Brennan, MSN, RN, CNL
Abstract:

Evidence-based Practice Abstract

Purpose: In the Emergency Department (ED), early identification of potential sepsis is vital for the prevention of severe sepsis and death. High ED census meant long ED wait times. Sepsis patients were not being identified until seen by a provider, at which point often needing vasopressors. The staff was knowledgeable about sepsis bundles, but needed empowerment to identify these patients before they reached severe sepsis. A plan to improve a sepsis indicator was developed. A triage sepsis screening tool, education plan, and audits were developed to promote sepsis screening on all patients entering the emergency department.

Design: Evidence-based quality assurance project.

Setting: Teaching, urban emergency department with 60,000 visits.

Participants/subjects: Emergency Department nursing staff, ED Physicians, Director of Emergency Services, Nurse Educator, Assistant Clinical Managers, Patient Safety Officer, ED Quality Improvement Coordinator.

Methods: The 2012 fiscal year goal to deliver antibiotics within three hours from arrival 85% of the time was set. Data indicated that the goal was often not being met. In the first eight months, the goal was exceeded in only two months. There was a challenge to improve this indicator. It was recognized that patients were not being identified early enough. ED nurses were on board with the Surviving Sepsis Campaign, felt knowledgeable, and wanted to see improvement. A plan to embed the sepsis screening tool into the electronic medical record was developed by nurses. Though this structural empowerment, sepsis screening would be mandatory on all patients that came through the ED door. The staff was educated on the tool and gave feedback within the first few weeks of using it. Changes were made to the tool according to staff feedback.

Results/Outcome: The plan was to have all patients screened at triage. This would identify those patients who were potentially at risk for sepsis as Emergency Severity Index level two and protocol orders could be initiated earlier. Chart audits showed that some patients were screened accurately, inaccurately, or not screened at all. The question of ‘presence of suspected infection’ raised debate among staff, which revealed subjective versus objective triage assessments. Ongoing chart audits and re-education including 1:1 discussions showed improved critical thinking by professional nurses and highlighted the importance of early intervention for sepsis. In the months following the rollout of the tool, the incidence of timely antibiotic and intravenous fluid administration rose to an average of 93%. Administration of antibiotics was consistently under three hours. The overall goal to deliver antibiotics in less than three hours was 83.7% for 2012, but it was recognized that the goal of 85% would have been easily achieved if the sepsis screening tool was initiated at the beginning of the fiscal year.

Implications: A sepsis screening-tool at triage offers ED nursing staff a practical way of assessing a patient at risk for sepsis in an easy-to-use, rapid assessment format. It encourages development of critical thinking skills and helps organizations achieve the improved patient outcomes.

Keywords:
Early identification of Sepsis
Repository Posting Date:
9-Dec-2013
Date of Publication:
9-Dec-2013
Conference Date:
2013
Conference Name:
2013 ENA Annual Conference
Conference Host:
Emergency Nurses Association
Conference Location:
Nashville, Tennessee, USA
Description:
2013 ENA Annual Conference Theme: Safe Practice, Safe Care. Held at Gaylord Resort and 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.titleMaking a Difference at Triage: Screening Everyone for Sepsisen_GB
dc.contributor.authorKane, Joanneen_GB
dc.contributor.authorRobin, Nancy M.en_GB
dc.contributor.authorBrennan, Deniseen_GB
dc.contributor.departmentNon-memberen_GB
dc.author.detailsJoanne Kane, RN, CEN, jodoh20@yahoo.com; Nancy M. Robin, MEd, RN, CEN; Denise Brennan, MSN, RN, CNLen_GB
dc.identifier.urihttp://hdl.handle.net/10755/306609-
dc.description.abstract<p>Evidence-based Practice Abstract</p><p>Purpose: In the Emergency Department (ED), early identification of potential sepsis is vital for the prevention of severe sepsis and death. High ED census meant long ED wait times. Sepsis patients were not being identified until seen by a provider, at which point often needing vasopressors. The staff was knowledgeable about sepsis bundles, but needed empowerment to identify these patients before they reached severe sepsis. A plan to improve a sepsis indicator was developed. A triage sepsis screening tool, education plan, and audits were developed to promote sepsis screening on all patients entering the emergency department.</p><p>Design: Evidence-based quality assurance project.</p><p>Setting: Teaching, urban emergency department with 60,000 visits.</p><p>Participants/subjects: Emergency Department nursing staff, ED Physicians, Director of Emergency Services, Nurse Educator, Assistant Clinical Managers, Patient Safety Officer, ED Quality Improvement Coordinator.</p><p>Methods: The 2012 fiscal year goal to deliver antibiotics within three hours from arrival 85% of the time was set. Data indicated that the goal was often not being met. In the first eight months, the goal was exceeded in only two months. There was a challenge to improve this indicator. It was recognized that patients were not being identified early enough. ED nurses were on board with the Surviving Sepsis Campaign, felt knowledgeable, and wanted to see improvement. A plan to embed the sepsis screening tool into the electronic medical record was developed by nurses. Though this structural empowerment, sepsis screening would be mandatory on all patients that came through the ED door. The staff was educated on the tool and gave feedback within the first few weeks of using it. Changes were made to the tool according to staff feedback.</p><p>Results/Outcome: The plan was to have all patients screened at triage. This would identify those patients who were potentially at risk for sepsis as Emergency Severity Index level two and protocol orders could be initiated earlier. Chart audits showed that some patients were screened accurately, inaccurately, or not screened at all. The question of ‘presence of suspected infection’ raised debate among staff, which revealed subjective versus objective triage assessments. Ongoing chart audits and re-education including 1:1 discussions showed improved critical thinking by professional nurses and highlighted the importance of early intervention for sepsis. In the months following the rollout of the tool, the incidence of timely antibiotic and intravenous fluid administration rose to an average of 93%. Administration of antibiotics was consistently under three hours. The overall goal to deliver antibiotics in less than three hours was 83.7% for 2012, but it was recognized that the goal of 85% would have been easily achieved if the sepsis screening tool was initiated at the beginning of the fiscal year.</p><p>Implications: A sepsis screening-tool at triage offers ED nursing staff a practical way of assessing a patient at risk for sepsis in an easy-to-use, rapid assessment format. It encourages development of critical thinking skills and helps organizations achieve the improved patient outcomes.</p>en_GB
dc.subjectEarly identification of Sepsisen_GB
dc.date.available2013-12-09T17:00:41Z-
dc.date.issued2013-12-09-
dc.date.accessioned2013-12-09T17:00:41Z-
dc.conference.date2013en_GB
dc.conference.name2013 ENA Annual Conferenceen_GB
dc.conference.hostEmergency Nurses Associationen_GB
dc.conference.locationNashville, Tennessee, USAen_GB
dc.description2013 ENA Annual Conference Theme: Safe Practice, Safe Care. Held at Gaylord Resort and 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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