education department needs to initiate a quality improvement project that measures the changes in early infection treatment based on changes in the sepsis screening algorithm. The goal is to understand if there are more early diagnoses of sepsis, earlier administration of antibiotics and intravenous fluids and improved patient outcome. Stakeholders Roles The floor RNs, need to be aware of recent advances in sepsis research and the value of qSOFA in conjunction with the SIRS criteria. They will have to change their practice and actively assess a patient's mental status for alertness and orientation to time, person, place, and situation whenever they assess vital signs. If they get sing-out, the description of mental status 3
Translational Research and Populations (such as alert and oriented to time, person, place, and situation) needs to be addressed for every patient and communicated in a standardized way. If the RN recognized changes in the mental status she also needs to assess for the other SIRS and qSOFA criteria. If a patient is SIRS or qSOFA positive the RN has to immediately inform the MD. The RN can trigger a sepsis alert in the electronic health record that will allow her to order blood cultures and a serum lactate. The physicians need to be briefed on the most recent findings of the assessment and clinical criteria for Sepsis to understand why the practice change has occurred. The IT department needs to create a standardized way of documenting a patient’s mental status that will be displayed together with other vital signs. The electronic health record needs to be programmed in a way that it automatically triggers sepsis alerts if SIRS or qSOFA criteria are met. That also will include automatic order sets of blood cultures and serum lactate. The IT and educational department will assign a multidisciplinary team consisting of a nurse an infectious disease physician a pharmacist and a statistician. The goal of this team is to assess changes in the diagnosis, treatment, and outcome of early sepsis after implementing the qSOFA score. Outcome measures are the number of new sepsis diagnoses, time to administration of antibiotics and intravenous fluids as well as mortality of patient's diagnosed with sepsis. This data will be compared to data from the previous year, where the diagnosis of sepsis was solely made by SIRS criteria. Evidence Summary Sepsis is a major public health concern with more than one million cases in the US per year, creating healthcare costs beyond $20 million dollars in 2011. Early recognition and treatment of sepsis can significantly reduce mortality and healthcare costs. Ferrer et al could show in a large retrospective study that one hour delay of the administration of antibiotics was 4
Translational Research and Populations associated with an increased probability of death. Given that it would be unethical to withhold antibiotic treatment in patients with suspected infections, randomized controlled trials cannot be done. This study included almost 20 thousand patients and has a very robust study design. These
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- Spring '16
- Nursing, Sepsis