Year of Publication

2018

Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Carol Thompson

Clinical Mentor

Dr. Jared Hagaman

Committee Member

Dr. Melanie Hardin-Pierce

Abstract

Objectives: To examine the use of a Modified Early Warning System (MEWS) for sepsis identification and evaluate its effects on treatment and outcomes for those patients diagnosed with sepsis after admission, during their stay at an acute care facility.

Design: A retrospective chart audit was conducted on the electronic medical records (EMRs) of patients who developed, and were diagnosed with, sepsis post admission. Specifically, a retrospective separate sample pretest posttest design was used to examine the accuracy of the MEWS, differences in outcomes (ICU days, length of hospital stay, qSOFA Score and mortality rates), and treatment initiation time (fluid resuscitation, antibiotic therapy, and lactate levels) during 12-months pre- and 12-months post-MEWS initiation.

Setting: This study was conducted at Ephraim McDowell Regional Medical Center (EMRMC), a 222-bed non-profit regional hospital that serves more than 119,000 residents from six counties in central Kentucky.

Patients: Inclusion criteria for the study were adults greater than or equal to 18 years of age, and an ICD-9 or ICD -10 diagnosis of sepsis, severe sepsis or septic shock post admission. Exclusion criteria were a sepsis diagnosis on admission, and patients younger than 18 years of age.

Interventions: A retrospective chart audit was completed to compare pre- and post-initiation of a MEWS for the identification of sepsis and to evaluate differences in treatment initiation and patient outcomes.

Measurements and Main Results: There were no differences found in the demographic variables between the pre- and post-MEWS samples including age, gender, and ethnicity. The ability of the MEWS to identify possible sepsis, severe sepsis, and septic shock before diagnosis was 92.3%. Compliance with treatment initiation was significantly increased with the ordering of lactates (p < .001), while marginally significant with antibiotic initiation (p=.052) as well as fluid resuscitation in septic shock (p=.054). No differences were found between ICU days or mortality rates. A significant 3.5 day decrease in length of stay was identified for the post-MEWS initiation sample, which resulted in an estimated $131,176 savings on room cost alone across the one year sample.

Conclusion: During the one year period post-initiation, the MEWS at EMRMC proved to be accurate at the identification of sepsis, severe sepsis, and septic shock before the diagnosis was made. In addition, compliance with treatment initiation and patient overall length of stay were positively affected and contributed to a significant cost savings. Adding the MEWS proved to be an accurate way to provide an increase in the quality of care while reducing healthcare costs.

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