Impact of Emergency Department Sepsis Policy
Lynette Rayman, DNP, RN, CNE, CCRN-A
- Sigma Affiliation
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Session J presented Saturday, September 16, 2017
Purpose: Sepsis and the care of sepsis patients impact the healthcare industry on a number of levels. It is a serious concern for health care providers, policy-makers, and patients due to the large number of cases, high mortality, and cost. The purposes of the project were to identify sepsis patients early during the triage process and implement Sepsis Evidence Based Order Sets within one hour of triage time. This was accomplished by the implementation of an ED sepsis policy.
This evidence-based project combined a Capstone DNP project with a quality improvment project.
Setting: The setting for this EBP project included two EDs affiliated with a not-for-profit hospital located in Northwest Indiana. One of the EDs is located within the main hospital and the other is a free-standing ED approximately 15 miles from the main hospital.
Participants/Subjects: This project compared pre-implementation (prior to policy initiation) to post-implementation (after policy initiation) data. Data were collected from electronic health records of patients utilizing the services of the two EDs and included all triaged patients > 18 years of age. . All ED staff participated in the policy implementation.
Methods: The intervention for this project was multi-faceted. The initial step was to identify and appraise the best evidence regarding ED care to potential sepsis patients. Once synthesized, the literature was integrated into an ED Sepsis policy. Education regarding the new policy was then provided to the Emergency Department staff both face to face and by a computer learning system. For this project three primary outcomes were monitored: staff compliance to the new sepsis policy, patient mortality, and patient length of stay. The primary outcomes of overall policy compliance and subcomponents of the policy were analyzed using chi-square test of independence to determine differences between the pre and post implementation groups. Patient mortality and length of stay information regarding the post implementation group were compared to organization’s first quarter data.
Results/Outcomes: A chi square test of independence was calculated comparing screening rates pre and post policy implementation. A significant interaction was found (X2(1) = 438.505, p < .001. Patients were more likely to be screened post policy implementation than pre implementation. Staff compliance with Sepsis Order Sets was also analyzed for the post implementation group and increased compliance with all components was demonstrated. Secondary outcomes of the post implementation group included a length of stay of 7.7 days and a mortality rate of 11.11% which showed a decrease from first quarter data.
Implications: Results demonstrate that implementation of a sepsis policy that includes a computer based screening tool and point of care lactate significantly impacts early identification of sepsis patients and leads to timely treatment with subsequent decreased length of stay and mortality. APNs are charged with promoting quality patient care. By synthesizing best practice evidence, implementing policy change, and monitoring and evaluating outcomes, patient care can be significantly and positively impacted.
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