Year of Publication

2017

Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Sheila Melander

Clinical Mentor

Brittany Ross

Committee Member

Dr. Michelle Pendleton

Abstract

PURPOSE: To evaluate the adherence to the CMS sepsis recommendations and sepsis bundle used by the study health system before and after the implementation of Best Practice Alerts (BPAs) and assessing the effect of these alerts on patient outcomes.

METHODS: The study was a single-center, process evaluation through a retrospective chart review within a southwest healthcare system. The sample consisted of 73 patients for the pre-implementation period (May 1, 2016-September 7, 2016) and 75 patients for the post-implementation period (September 8, 2016-April 30, 2017).

RESULTS: No major differences were found between the two groups with regard to patient age, ethnicity, and time of admission. The post-implementation group had a higher incidence of timely antibiotic administration (p=.008) with 38% receiving initial antibiotic administration in 45 minutes or less of meeting sepsis criteria versus 21% in the pre-implementation group. In the post-implementation group, 89% of patients met sepsis criteria versus 67% in the pre-implementation group. The post-implementation group also collected blood cultures in 30 minutes or less in 61% of patients versus 41% in the pre-implementation group (p=.03). No significant difference was found in regard to antibiotic selection, mortality, or length of stay.

CONCLUSION: The post-implementation group achieved more timely antibiotic administration and blood culture collection; however, there was no significant improvement in appropriate antibiotic choice, length of stay, or mortality. BPAs were inconsistent with the time that patients met sepsis criteria. After years of research and protocol changes, outcomes have not improved, indicating a great need for consideration of alternative treatments to improve the care and outcomes of sepsis patients.

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