2.50
Hdl Handle:
http://hdl.handle.net/10755/344167
Category:
Abstract
Type:
Poster
Title:
Optimizing Management of Sepsis in the Emergency Department
Author(s):
Brubaker, Freddi; Hashemi,Phyllis; Brown, Martin; McCain Johnson, Mary Vanessa
Lead Author STTI Affiliation:
Non-member
Author Details:
Freddi Brubaker, MSN, RN, CEN, CCRN, freddica.brubaker@inova.org; Phyllis Hashemi, PharmD, BCPS; Martin Brown, MD, FACEP; Mary Vanessa McCain Johnson, MBA, BSN, RN, CEN, CPEN
Abstract:
Evidence-based Practice Abstract Purpose: Sepsis is a leading cause of death in hospitals. Early goal-directed therapy leads to significant improvement in clinical outcomes. Studies show that for each hour delay in administration of appropriate antibiotics after the onset of hypotension, patient mortality increases by 7.6%. The aim of this project is to provide evidence-based protocols in order to identify early signs of sepsis and provide rapid treatment through development and implementation of the Emergency Department (ED) Sepsis Bundle and Code Sepsis. Design: This evidence-based, staff driven, quality-improvement project was facilitated by a multidisciplinary team which included ED nursing staff, pharmacists and physicians. The main components included staff education, protocol implementation and continuous data analysis. Setting: This project was implemented in a 41 bed ED of a non-profit, community hospital. The majority of the more than 400 patients diagnosed with sepsis annually are admitted through the ED. Participants/Subjects: All admitted patients diagnosed with severe sepsis and/or septic shock. Methods: Recommendations from the Surviving Sepsis Campaign Guidelines were developed to include screening tools incorporating diagnostic criteria. Based on the guidelines, the team developed four essential goals of treatment which we termed the “ED Sepsis Bundle”. These goals consist of obtaining blood cultures, lactic acid and administration of antibiotics and intravenous fluids. The objective is to complete the ED Sepsis Bundle within one hour of identification of severe sepsis or septic shock. Through real-time analysis of patient cases, we determined there was a need for a formalized “Code Sepsis” approach. The team designed a process that delineated the roles and responsibilities of ED nurses and EMTs. The staff was educated during huddles and meetings and through review of informational pocket cards. Ongoing, real-time patient cases were evaluated with prompt provider feedback to assess compliance with the ED Sepsis Bundle, assure sustainability of the gains achieved and identify areas for continued improvement. Results/Outcomes: The average time to antibiotics prior to initiation of this project was 125 minutes. Post-intervention the time to antibiotics has decreased to an average time of 68 minutes. The compliance for completing the ED Sepsis Bundle within one hour has increased from 23% to 47%. Notably, post-implementation of Code Sepsis led to a further decrease in time to antibiotics: 84 minutes (pre-code-sepsis n=89) to 57 minutes (n=130). The latter assessment highlights the impact of continuous evaluation and improvement efforts. Ongoing monitoring (including plans for statistical assessment) will continue. Implications: Using a multi-disciplinary team approach we effectively developed and implemented treatment recommendations aimed to take advantage of the golden hour of sepsis treatment. Data analysis reveals improvements in time to administration of antibiotics and increased compliance of the ED Sepsis Bundle. It is imperative for the leadership team to provide ongoing monitoring and feedback with the clinical staff to ensure continuous improvement and adherence to the protocols. In addition, key factors to success include provision of effective education as well as constant promotion of cohesive teamwork and communication.
Keywords:
Sepsis; Managing Sepsis in ED
Repository Posting Date:
4-Feb-2015
Date of Publication:
4-Feb-2015
Conference Date:
2014
Conference Name:
2014 ENA Annual Conference
Conference Host:
Emergency Nurses Association
Conference Location:
Indianapolis, Indiana, U.S.A.
Description:
2014 ENA Annual Conference Theme: Safe Practice, Safe Care. Held at the Indiana 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. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.

Full metadata record

DC FieldValue Language
dc.language.isoen_USen_GB
dc.type.categoryAbstracten_GB
dc.typePosteren_GB
dc.titleOptimizing Management of Sepsis in the Emergency Departmenten_GB
dc.contributor.authorBrubaker, Freddien_GB
dc.contributor.authorHashemi,Phyllisen_GB
dc.contributor.authorBrown, Martinen_GB
dc.contributor.authorMcCain Johnson, Mary Vanessaen_GB
dc.contributor.departmentNon-memberen_GB
dc.author.detailsFreddi Brubaker, MSN, RN, CEN, CCRN, freddica.brubaker@inova.org; Phyllis Hashemi, PharmD, BCPS; Martin Brown, MD, FACEP; Mary Vanessa McCain Johnson, MBA, BSN, RN, CEN, CPENen_GB
dc.identifier.urihttp://hdl.handle.net/10755/344167-
dc.description.abstractEvidence-based Practice Abstract Purpose: Sepsis is a leading cause of death in hospitals. Early goal-directed therapy leads to significant improvement in clinical outcomes. Studies show that for each hour delay in administration of appropriate antibiotics after the onset of hypotension, patient mortality increases by 7.6%. The aim of this project is to provide evidence-based protocols in order to identify early signs of sepsis and provide rapid treatment through development and implementation of the Emergency Department (ED) Sepsis Bundle and Code Sepsis. Design: This evidence-based, staff driven, quality-improvement project was facilitated by a multidisciplinary team which included ED nursing staff, pharmacists and physicians. The main components included staff education, protocol implementation and continuous data analysis. Setting: This project was implemented in a 41 bed ED of a non-profit, community hospital. The majority of the more than 400 patients diagnosed with sepsis annually are admitted through the ED. Participants/Subjects: All admitted patients diagnosed with severe sepsis and/or septic shock. Methods: Recommendations from the Surviving Sepsis Campaign Guidelines were developed to include screening tools incorporating diagnostic criteria. Based on the guidelines, the team developed four essential goals of treatment which we termed the “ED Sepsis Bundle”. These goals consist of obtaining blood cultures, lactic acid and administration of antibiotics and intravenous fluids. The objective is to complete the ED Sepsis Bundle within one hour of identification of severe sepsis or septic shock. Through real-time analysis of patient cases, we determined there was a need for a formalized “Code Sepsis” approach. The team designed a process that delineated the roles and responsibilities of ED nurses and EMTs. The staff was educated during huddles and meetings and through review of informational pocket cards. Ongoing, real-time patient cases were evaluated with prompt provider feedback to assess compliance with the ED Sepsis Bundle, assure sustainability of the gains achieved and identify areas for continued improvement. Results/Outcomes: The average time to antibiotics prior to initiation of this project was 125 minutes. Post-intervention the time to antibiotics has decreased to an average time of 68 minutes. The compliance for completing the ED Sepsis Bundle within one hour has increased from 23% to 47%. Notably, post-implementation of Code Sepsis led to a further decrease in time to antibiotics: 84 minutes (pre-code-sepsis n=89) to 57 minutes (n=130). The latter assessment highlights the impact of continuous evaluation and improvement efforts. Ongoing monitoring (including plans for statistical assessment) will continue. Implications: Using a multi-disciplinary team approach we effectively developed and implemented treatment recommendations aimed to take advantage of the golden hour of sepsis treatment. Data analysis reveals improvements in time to administration of antibiotics and increased compliance of the ED Sepsis Bundle. It is imperative for the leadership team to provide ongoing monitoring and feedback with the clinical staff to ensure continuous improvement and adherence to the protocols. In addition, key factors to success include provision of effective education as well as constant promotion of cohesive teamwork and communication.en_GB
dc.subjectSepsisen_GB
dc.subjectManaging Sepsis in EDen_GB
dc.date.available2015-02-04T11:27:41Z-
dc.date.issued2015-02-04-
dc.date.accessioned2015-02-04T11:27:41Z-
dc.conference.date2014en_GB
dc.conference.name2014 ENA Annual Conferenceen_GB
dc.conference.hostEmergency Nurses Associationen_GB
dc.conference.locationIndianapolis, Indiana, U.S.A.en_GB
dc.description2014 ENA Annual Conference Theme: Safe Practice, Safe Care. Held at the Indiana 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. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.en_GB
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