Journal Club

Sepsis is a life threatening condition. This study is focused on improving patient outcomes with a 3-hour sepsis care bundle. Early detection can help to improve positive patient outcomes. A checklist using the DART protocol was put in place by this study to determine if nurses could implement sepsis care at an early stage in the patient’s care. 90 charts were reviewed prior to implementing the checklist and researchers found that only 30% was compliant with sepsis care. One month in to the implementation period 50% was compliant with the sepsis care bundle. After the implementation period, 80% were compliant with quality reporting metrics. The study showed that nurse driven protocols can help to improve patient’s outcomes significantly. After the study was completed, a survey was sent to the nurses. They reported that the checklist was helpful in making sure that everything was completed in a time sensitive manner for the sepsis care bundle.

References

Moore, W. R., Vermuelen, A., Taylor, R., Kihara, D., & Wahome, E. (2019). Improving 3-Hour Sepsis Bundled Care Outcomes: Implementation of a Nurse-Driven Sepsis Protocol in the Emergency Department. Journal of Emergency Nursing, 45(6), 690–698. doi: 10.1016/j.jen.2019.05.005

 

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12 Responses

  1. Cassie, RN at |

    Teles et al (2017) stated in their study that patients who were screened and treated using a 3 hour sepsis bundle had a mortality rate reduction of 44% compared to those who did not. While sepsis screenings and protocols are always evolving what do you think can be done to close that gap on the 20% who are not compliant? Is more education needed? Would a break down of the charting find a break down in the system? What do you think is holding us back from a 100% coverage rate. We all know how important it is to catch sepsis early.

    Teles, F., Rodrigues, W. G., Alves, M. G. T. C., Albuquerque, C. F. T., Bastos, S. M. O., Mota, M. F. A., Mota, E. S., & Silva, F. J. L. (2017). Impact of a sepsis bundle in wards of a tertiary hospital. Journal of Intensive Care, 5, 1–5. https://doi-org.ezproxy.fhsu.edu/10.1186/s40560-017-0231-2

  2. Kristen at |

    Sepsis is a life-threatening emergency and in 2017 an estimated 48.9 million cases of sepsis were documented worldwide (Rudd et. al, 2019). Having a safety bundle readily available is helpful to ensure that everything is done timely and correctly. There have been many different types of “bundles” adopted by emergency departments throughout the world with the same goal of giving the patient the best possible outcome. Compliance with the bundles and protocols seem to be a problem everywhere. Right now, during the Covid-19, the argument could be made in some cases that there is not enough staff to complete everything on time. Another possibility could be that staff were just told to do enact these protocols and bundles but do not fully understand the importance of it. Perhaps more education is needed?

    Frankling, C., Patel, J., Sharif, B., Melody, T., Yeung, J., Gao, F., & Szakmany, T. (2019). A Snapshot of Compliance with the Sepsis Six Care Bundle in Two Acute Hospitals in the West Midlands, UK. Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine, 23(7), 310–315. https://doi.org/10.5005/jp-journals-10071-23204

    Rudd, K. E., Johnson, S. C., Agesa, K. M., Shackelford, K. A., Tsoi, D., Kievlan, D. R., Colombara, D. V., Ikuta, K. S., Kissoon, N., Finfer, S., Fleischmann-Struzek, C., Machado, F. R., Reinhart, K. K., Rowan, K., Seymour, C. W., Watson, R. S., West, T. E., Marinho, F., Hay, S. I., Lozano, R., … Naghavi, M. (2020). Global, regional, and national sepsis incidence and mortality, 1990-2017: analysis for the Global Burden of Disease Study. Lancet (London, England), 395(10219), 200–211. https://doi.org/10.1016/S0140-6736(19)32989-7

  3. lvmezavega2 at |

    I work on a respiratory step-down unit, so we frequently admit patients with sepsis. One thing I have noticed with the sepsis checklists in my facility are that they are printed pieces of paper that the ED nurses start to check-off in the ED and send up with the patient, once they are admitted. Sadly, I rarely see these checklists be used or followed-up on once on the unit.
    Early recognition is imperative for prompt treatment of sepsis. “The reduction in in-hospital mortality rate and hospital readmission rate confirms that the Surviving Sepsis Guideline revisions and updates are improving patient care resulting in better outcomes” (Farrell & Casserly, 2018).
    The study you discussed supports this statement. Still, a 20% that is unaccounted for remains. Like our peers, I too question what could be done to lessen the gap. Also, did you come across any information related to the proposed 1-hour sepsis bundle? If so, what were your thoughts on it?

    Farrell, C., & Casserly, B. (2018, October 30). Sepsis, the earlier the better, 3- to 1-hour bundle. Retrieved from http://jeccm.amegroups.com/article/view/4712/5253

  4. jbonilla at |

    Megan,
    Patient outcomes is dependent on appropriate therapy and the early initiation of sepsis bundles. Implementation of sepsis bundles, education for early detection and treatment can help lower patient mortality. This is something that should be implemented throughout all hospitals to help improve outcomes for this at risk group.

    Reference:

    McColl, T., Gatien, M., Calder, L., Yadav, K., Tam, R., Ong, M., . . . Stiell, I. (2017). Implementation of an emergency department sepsis bundle and system redesign: A process improvement initiative. CJEM : Journal of the Canadian Association of Emergency Physicians, 19(2), 112-121. doi:http://dx.doi.org.ezproxy.fhsu.edu:2048/10.1017/cem.2016.351

  5. ajmurphy4 at |

    Early sepsis detection is key to a better patient prognosis. The DART checklist is an extremely helpful tool to help nurses identify sepsis. In an article by (Burog et al;2020) they focus on educating nurses on the signs and symptoms of sepsis as well as the screening tools used within the charting system. Is further nursing education beneficial to improving the outcomes of patients seen in the ER? Would the education make a difference in the emergency setting?

    Burog, R. Carrion, J. Luna, N. Silverstr-Elmore, A. Turner, B.S.(2020) A quality Improvement Project to Evaluate the Implementation of a Sepsis Education Program in a Medical-Surgical Department. Medsurg Nursing; Vol 29, Iss. 1, pg34-37

  6. hngonzalez at |

    I found an article that talks about the 1 hour bundle and all that entails with following that protocol. The 1 hour bundle encourages clinicians to act as quickly as possible to obtain blood cultures, administer broad spectrum antibiotics, start appropriate fluid resuscitation, measure lactate, and begin vasopressors if clinically indicated. Reading the article the 1 hour bundle seems like it would be ideal but the fact everything would ideally be done in that hour may not be realistic. But as long as we do are best to start intervention as early as possible to help the patient.

    SCCM: Adult Patients. (n.d.). Retrieved from http://www.sccm.org/SurvivingSepsisCampaign/Guidelines/Adult-Patients

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