Nancy J. Fry, BSN, RN, CEN; Dana Miller, RN
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Purpose: With an increasing number of patients being diagnosed with sepsis there was a need for increased awareness, improved education strategies, and updated initiatives at this level 1 trauma center to decrease mortality and improve bundle compliance. Sepsis is a time sensitive diagnoses and with many of these septic patients being treated, diagnosed, and admitted through the Emergency Department specific ED measures and goals were put into place to diminish time to diagnosis for these patients and help improve overall results of the hospital.
Design: Data collected by the hospital sepsis coordinator after abstraction was placed into graphs. With retrospective chart review outcomes have been analyzed since January 2015 (Quarter 1 2015) to determine changes in patient mortality and bundle compliance for both severe sepsis and septic shock. While the chart review for is for this level 1 trauma center as a whole, this study will be focused on the specific strategies implemented by the Emergency Department to help achieve those overall sepsis goals.
Setting: The project was implemented at an urban level 1 trauma center in Englewood, Colorado.
Participants/Subjects: This study includes all ED staff participation while paying close attention to collaboration between ED RNs, ED techs, and ED providers.
Methods: An ED Clinical Nurse Coordinator Sepsis Champion worked alongside the hospital Sepsis Coordinator therefore improving consistency and communication throughout the hospital through a monthly hospital sepsis meeting for collaboration between multifaceted staff in the hospital. The ED Sepsis Coordinator assembled a monthly ED Sepsis Taskforce meeting for improved ED education and initiatives. An orange communication sheet was introduced for improved communication between the ED and the floors on admitted patients. Sepsis Taskforce members were assigned new hires to discuss sepsis expectations with standardized care. The ED educator added sepsis information to new hire orientation and sepsis refresher points to annual ED skills. The ED sepsis coordinator follows up with ED staff on all sepsis fallouts personally or via email. A standardized ED provider order set was created for use on septic patients with a lactate greater than 2. Orders are able to be disabled or added depending on severe sepsis versus septic shock diagnoses.
Results/Outcomes: Severe Sepsis Mortality: an average of 8.3% in 2015 to 4.9% in 2017 with a goal of <10%; Septic Shock Mortality: an average of 33.3% in 2015 to 21.1% in 2017 with a goal of <30%; Severe Sepsis Bundle Compliance: an average of 55.7% in 2015 to 65.5% with a goal of >65%; Septic Shock Bundle Compliance: an average of 63.1% in 2015 to 72. 5% with a goal of >65%; (December 2017 is not yet resulted to inclusion in this study, it will be added at a future date). Implications: Our quality assurance project based on evidence based CMS guideline practices and core measures demonstrates that a collaboration between ED nurses, techs, and providers along with communication to hospital attending physicians and inpatient staff can lead to a significant decrease in patient mortality and increase bundle compliance for patients presenting with severe sepsis or septic shock symptoms.
Emergency Nursing 2018. Held at David L. Lawrence Convention Center, Pittsburgh, Pennsylvania, USA
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Skaggs, Mary Kate Dilts; Hodge, Angela J. (2017-12-04)Purpose: Sepsis is the leading cause of death in non-coronary intensive care units and the tenth leading cause of death in the United States overall. One in one-hundred eighty five Americans were expected to be ...
Crimmins-Bonnell, Donna; Greenberg, April; McAdams, Ashlee (2017-12-04)Purpose: Lean Six Sigma Yellow Belt Project chartered to increase the use of our Sepsis Checklist as we were at 0% compliance and our Mortality OE was 1.35. Aim: Primary: to increase initiation of Sepsis checklist, by 50% ...
Fry, Nancy J.; Cotter, SamanthaPoster presentationSession D presented Monday, September 30, 2:30-3:30 pmPurpose: With an increasing number of patients being diagnosed with sepsis, there was a need for increased awareness, improved educational strategies, ...
Implementation of an opioid reduction protocol utilizing alternatives for the treatment of pain in the emergency department of a level 1 trauma center Duncan, Rachael; Fry, Nancy J.; Maguire, Michelle (2017-12-04)Purpose: Pain is the number one reason for emergency department visits in the United States. Many ED physicians find it quick and effective to prescribe opioids for patients that present complaining of pain. In many cases, ...
Humiston, Lauren; Duncan, Rachael; Fry, Nancy J. (2017-12-04)Purpose: Medication reconciliation should be performed at all transitions of care according to the Institute for Healthcare Improvement and AHRQ Patient Safety Network. A recent systematic review on errors in medication ...