IMPLEMENTATION OF A SEPSIS PROTOCOL: A QUALITY IMPROVEMENT PROJECT

Sepsis is the leading cause of death among hospitalized patients but with rapid identification, assessment, and treatment, positive patient outcomes can be achieved. Utilizing the Model of Improvement framework, aim one of this quality improvement project employed a nurse-driven sepsis protocol incorporating the nationally recognized Surviving Sepsis Campaign (SSC) guideline to improve patient outcomes in all units in a community hospital in Southern California. Utilizing the rapid sepsis assessment form, nurses were able to quickly identify signs of sepsis to initiate the nurse-driven protocol to begin life-saving interventions without waiting for physician orders (except for antibiotic selection). SSC bundle elements included lactic acid measurement, blood culture measurement, administration of broad spectrum antibiotic, administration of intravenous fluids, administration of vasopressors, and central venous pressure monitoring; treatments were started as soon as sepsis was validated. The baseline period of this project took place from November to December 2013. The postimplementation period was November to December 2014. Outcomes evaluated before and after protocol implementation were SSC bundle compliance rate, sepsis patient mortality from all units of hospital, and average hospital length of stay. For aim two of this project, increase in nursing staff knowledge through education were compared before and immediately after sepsis education utilizing a questionnaire. Nurse attitudes about the sepsis epidemic in relationship to sepsis knowledge were also compared. The questionnaire included eight questions assessing attitudes of nurses about the sepsis iv epidemic and nine questions assessing nurses’ knowledge of recognizing the signs and symptoms of sepsis and had face validity. The questionnaire was administered to nurses who voluntarily participated from all the units before and immediately after a 90-minute sepsis education during the unit staff meetings in fall 2014 with 50% attendance rate. For aim one, sepsis audit via retrospective chart review revealed that SSC bundle compliance improved with a nurse-driven sepsis protocol. Completion rate of lactic acid went from 64.3% to 88.2% and blood culture completion rates went from 69.2% to 912%, vasopressor use from 78.6% to 97.2%, and central venous pressure measurement from 47.6% to 70.6%. Mortality rate and hospital length of stay decreased post implementation although not statistically significantly; lack of significance was most likely due to small sample size. For aim two, nurses’ knowledge after sepsis education improved in recognizing specific signs and symptoms of sepsis. Despite these encouraging findings and given the fact that only 50% of nurses completed sepsis education, conclusions cannot be drawn about a cause-effect relationship between nurse knowledge and patient outcomes. Future studies are necessary to address the limitations and to determine the most effective way to achieve higher sepsis bundle compliance and to evaluate nurses’ awareness of sepsis in relation to patient outcomes