Examining the Effects of a Hi-Fidelity Simulation on Sepsis Identification, Compliance with the Sepsis Bundle and Documentation of a Warning Score

One of the most critical points of a patient's visit to the Emergency Department (ED) is the initial triage process in which a Registered Nurse will sort the patient into acuity levels to determine which patients will require the resources of the department by priority, so optimal outcomes are achieved. Identifying sepsis at ED triage is challenging due to the subtle physiological cues being missed, over-reliance on intuition, and lack of appropriate warning scores or tools for the triage nurse to identify these subtle clues (Yurkova & Wolf, 2011). Under-triage or non-recognition of the septic patient causes a delay in proper sepsis management and longer ED length of stay (LOS). This evidenced-based practice project examined the effects of a hi-fidelity simulated event on the under triaging of septic patients, sepsis identification, compliance with the sepsis bundle and utilization compliance of a national early warning score on septic patients. Identifying how early recognition, accurate triage, the use of an early warning score, impacts the critical septic patient in the ED is important to potentially decrease the mortality in the identified population. A retrospective chart review was conducted on ED charts with the diagnosis of sepsis from the dates of 4/8/2018 to 4/15/2018. The following de-identified data was collected: age, gender, ED arrival time, National Early Warning Score (NEWS) upon triage, ESI triage level, antibiotic administration order, antibiotic administration time, IV fluid administration order, IV fluid administration start time, mortality, and ED discharge time. A high-fidelity simulation was conducted with the ED staff focusing on sepsis identification, implementation of the sepsis bundle and completion of the warning score. Two weeks after the high fidelity simulation another retrospective chart review was conducted analyzing the same variables.D.N.P., Nursing Practice -- Drexel University, 201