Year of Publication
Doctor of Nursing Practice
Dr. Melanie G. Hardin-Pierce
Dr. Robyn Cheung
Dr. Chizimuzo T. Okoli
Background: Sepsis, defined as a systemic inflammatory response to infection, is a life-threatening medical condition that rapidly progresses from severe sepsis (characterized by signs of organ dysfunction) to septic shock with fluid-refractory hypotension. Adherence to the Surviving Sepsis Campaign guidelines for the management of severe sepsis and septic shock have been associated with improved delivery of care and reduced mortality. Delays in recognition of sepsis has been identified as a barrier to achieving early goal-directed therapy targets.
Purpose: To determine if a sepsis screening protocol could facilitate earlier identification of patients with sepsis
Methods: A retrospective medical record review was conducted for adult patients with a primary or secondary diagnosis of sepsis using ICD-9 codes 038.9 (unspecified septicemia), 995.91 (sepsis), 995.92 (severe sepsis), and 785.52 (septic shock). A sepsis screening strategy was applied retrospectively to simulate implementation of a screening protocol. Application of the screening strategy was performed to quantify the interval between when clinicians first recognized sepsis and when patients first exhibited signs of systemic inflammatory response syndrome (SIRS).
Results: The median interval of time between when a clinician recognized sepsis and when a patient first exhibited signs of sepsis was 222 minutes. A difference in time occurred in 22% of the cases. Duration of the interval was positively correlated with hospital length of stay (rs = .65, n = 17, p = .005).
Conclusion: The interval between when patients with sepsis were first identified by a clinician (without screening) and when those patients could have been recognized utilizing a screening protocol was quantified. Results suggest that more than one in five patients would have been identified earlier using a screening protocol. A pilot study to further investigate the potential impact of sepsis screening on time to identification is warranted.
Fisher, Amy P., "Screening for Sepsis: A Key Strategy for Early Identification and Management of Septic Patients" (2014). DNP Projects. 31.