Year of Publication

2015

Degree Name

Doctor of Nursing Practice

Committee Chair

Dr.Melanie Hardin-Pierce

Clinical Mentor

Dr.Elizabeth Burckhardt

Committee Member

Dr.Susan Frazier

Abstract

Background: Sepsis is defined as a “systemic response to an active infectious process in the host” and “represents the systemic inflammatory response to the presence of infection” (American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference, 1992, p.865). In 2008, an estimated 727,000 patients were hospitalized with a diagnosis of sepsis, an increase from 326,000 in 2000, or a 55% increase in prevalence over the eight-year period (Hall, Williams, DeFrances, & Golosinskiy, 2011). Early identification of sepsis with early and effective management strategies has been shown to improve patient outcomes and decrease mortality and prevent organ dysfunction (Levy et al., 2010). Outcomes related to gender differences have not been widely examined in the septic patient; however, women with sepsis managed in the emergency department received less early goal directed therapy when compared to men (Mikkelsen et al., 2010).

Purpose: The purpose of this project was to evaluate adherence to four components of the sepsis protocol in the emergency department and intensive care unit at a central Kentucky community hospital. The four components were based on the 2012 revisions of the Surviving Sepsis Campaign Guidelines (Dellinger, 2013) and included antibiotic administration time, blood culture collection, serum lactate measurement, and fluid resuscitation. Mortality and adherence to the 4 sepsis protocol components was analyzed between genders.

Setting: The study took place at a 173-bed central Kentucky community hospital; data were extracted from the medical records of patients who were admitted through the emergency department (ED) and transferred to the intensive care unit for actual or potential sepsis/septic shock.

Population: Men and women aged 18 years of age (n = 32) and older, with an ICD-9 diagnosis code of sepsis (995.91), septic shock (785.52) or severe sepsis (995.92) on admission or during the ICU stay, and who were admitted through the ED into the ICU, or directly admitted to the ICU from the ED were included.

Design and Methods: A retrospective, descriptive comparative design was used for this practice inquiry. The medical record review included records from the date the sepsis protocol began on March 6th, 2014 through October 10th 2014; 32 patients met inclusion criteria and data were extracted from those medical records.

Results: Patients were Caucasian (100%) aged 77 + 12 years; half were male. A majority of patients died during their hospital stay (59%); on average, patients were hospitalized for 7.3 + 6.3 days. Only 34% of patients correctly received all four components of the sepsis protocol. Adherence was highest for antibiotic administration (91% adherent) and blood culture (94% adherent); approximately half of patients had serum lactate measured and received appropriate fluid resuscitation (53%). There were no differences in adherence based on patient gender (p > 0.05).

Conclusion: Only around one third of patients received all 4 components of the protocol. Additional strategies are required to ensure adherence with all components of this protocol, as prior data demonstrate that patient outcomes are significantly improved with protocol adherence.

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