Improving Early Sepsis Identification on Inpatient Units

Background: On October 1, 2015, the United States Centers for Medicare and Medicaid Services (CMS) issued a core measure addressing the care of septic patients. Now that care for sepsis patients is a core measure, it is important that all healthcare providers are knowledgeable in how to treat and identify sepsis. Purpose: The Purpose is to be a “values-driven integrated healthcare delivery system in collaboration with those who share our values.” Patients observed were ages 18-years-old and older from five inpatient units. The professionals in this hospital consisted of a multidisciplinary approach that included, but not limited to, a team of physicians, nurse practitioners, registered nurses, licensed vocational nurses, nursing assistants and respiratory therapists. The inpatient unit processes provide inpatient acute care that include patient stabilization and treatment tailored to each individualized care plan. The patterns on this unit are similar to the processes. Setting: This large metropolitan hospital is licensed to operate 384 beds and offers many different services ranging from emergency room, intensive care, as well as maternity and pediatric. Methods: A root cause analysis (RCA) was performed to identify gaps in the hospital’s sepsis protocol. Students worked with the Director of the Sepsis Screening Committee to develop a “Sepsis Screening Observation Checklist.” Next, a chart review audit was conducted by using a “Sepsis Chart Screening Data” form, which allowed students to review EMR charts of 100 patients in five different nursing units. Students also provided nurses with questionnaires to test their baseline theory and operational knowledge of early sepsis identification and hospital protocol specifics. Results: Using the first method, results showed 42% of patients had sepsis screenings completed in the EMR within the first three hours of their primary nurses coming onto their shift. 93% of the nurses who did complete the sepsis screening within the first three hours of the shift used vital signs that were obtained between 5am - 10am. 32% of the completed sepsis screenings indicated the patient did have a suspected/confirmed infection. 18% of the completed sepsis screenings showed suspected/confirmed infection with two SIRS criteria and only 7% initiated the sepsis protocol. Using the second method, results showed 72% of chart review audits completed the sepsis screening within the first three hours of beginning the shift. 3% of the sepsis screenings indicated the patient was positive for sepsis, while only 1% initiated the sepsis bundle. Conclusion: It was identified that sepsis adherence is an issue at this large metropolitan hospital. Interventions were unable to be implemented. With the help of interventions, sepsis can be identified early and treatable