Poster Presentation

Worldwide there are approximately 18 million new cases of sepsis each year, with a mortality rate range estimated about 30% to 60%.

Sepsis is the 10th leading cause of death in the United States.

Organ failure occurred in 19.1 % of sepsis patients from 1979 to 1989 and 30.2% from 1990 to 2000.

Severe sepsis as the primary diagnosis increased from 326,000 in 2000 to 727,000 in 2008.

Severe sepsis as the secondary diagnosis increased from 621,000 in 2000 to 1,141,000 in 2008.

About 24 % of patients who develop severe sepsis or septic shock will do so in a Medical-Surgical unit.

Severe sepsis strikes about 750,000 Americans annually

28%-50% of these people die., more U.S. deaths than from prostate cancer, breast cancer and AIDS combined

Sepsis is on the rise due to: Aging population, increased longevity of people with chronic diseases, spread of antibiotic-resistant organisms, increase in invasive procedures, broader use of immunosuppressive and chemotherapeutic agents

Background

Problem Statement

Healthcare Practice:

Nurses early sepsis recognition and management.

Healthcare Outcomes:

Improve sepsis mortality and morbidity rates.

Healthcare Delivery:

Improve awareness about the subject of sepsis in medical surgical units.

Potential Core Measure.

Healthcare Policy:

Generate policy changes beyond the local municipal government

References

Quasi Experimental, non-randomized one group pre test-posttest design.

Retrospective review of the data

Pre-Implementation

Education

Implementation

Post-Implementation

Power Analysis

Sepsis Hospital Length of Stay

Level of significance (α error probability), power (1-β error probability) and effect size.

Cohen’s recommendation

α value was set at 0.05

β value was set at 0.95.

Anticipated effect size (Cohen’s d) was set as medium effect, 6% of the variance: d=0.5

n=256

Transfers to Higher level of Care

Cramer’s V table chi-square

α value was set at 0.05

power set at 0.80

V statistics set at 0.30

n=174

Phase 1: Approval

Generate administration and management support for the project: Project proposal was presented to Unit Manager, Director and Hospital Nursing Council for approval. Project was also presented to Medical Executive Committee for approval.

Education was performed to all medical surgical nurses on the topic of sepsis in the pilot unit. All participating staff received a 30-45 minutes education program, including a PowerPoint presentation and education flyers regarding the study.

Phase 2: Development of Bundle

A sepsis bundle (Tool, Algorithm and Order Set) was developed for medical surgical units following the recommendations of the SSC 2012.

The sensitivity and specificity of a severe sepsis tool was calculated. Total number of admissions from pilot unit during a three month period was collected. Admitted patients with a discharge diagnosis of sepsis was attained. All patients that had at least one positive screening for severe sepsis was calculated. Those patients with a discharge diagnosis of sepsis but screened negative for sepsis was also calculated. The results yielded the sensitivity and specificity of the tool by utilizing a 2x2 designs and receiver operating curve.

Phase 3: Implementation

Decrease hospital length of stay: retrospective data collection will be conducted on all patients who have screened positive for sepsis during a three month period prior from implementation with focus on hospital length of stay. The same method will be employ after the implementation of the new sepsis bundle. With again focus on hospital length of stay. An independent t-test will be utilized to obtain results and measure outcome.

Decrease septic patients transfer to higher level of care: retrospective study will be conducted on all patients who have screened positive for severe sepsis during a three month period with focus on transfers to higher level of care. The same method will be utilized after the implementation of the new algorithm and sepsis bundle. With focus on transfer to higher level of care on all patients that screen positive for severe sepsis. A chi-square will be utilized to obtain results and measure outcome.

Phase 4: Data Analysis

Data Analysis and Presentation of Outcomes to Stakeholders.

Phase 5: Evaluation

Evaluation of Project.

Anderson, R. & Schmidt, R. (2010). Clinical biomarkers in sepsis. Front Bioscience (Elite Edition), 2(5), 504-520.

Carter, C. (2007). Implementing the severe sepsis care bundles outside the ICU by outreach. Nursing Critical Care, 12(5), 225-230.

Gyang, E., Shieh, L., Forsey, L., & Maggio, P. (2011). A simple screening tool for the early identification of sepsis in a non-icu setting. Poster session presented at: Surgical infection society. 31st Annual Conference of the Surgical Infection Society. May 11-14, Palm Beach, Fl.

Hall, M. J., Williams, S. J., DeFrances, C, J., & Golosinskiy, A. (2011). Inpatient care for septicemia or sepsis: A challenge for patients and hospitals. Centers for Disease Control and Prevention National Center for Health Statistics, 62, Retrieved from: http://www.cdc.gov/nchs/data/databriefs/db62.pdf.

Sankar, V. & Webster, N. R. (2013). Clinical application of sepsis biomarkers. Journal of Anesthesia, 27, 269-283.

Singer, M. (2013). Biomarkers in sepsis. Current Opinion in Pulmonary Medicine, 19(00), 1-5.

Tazbir, J. (2012). Early recognition and treatment of sepsis in the medical-surgical setting. Medical Surgical Nursing, 21(4), 205-208.

Tromp, M., Tijan, D. H. T., van Zanten, A. R. H., Gielen-Wiffels, S. E. M., Goekoop, G. J. D., Van den Boogaad, M., Wallenborg, C. M., Biemond-Moeniralam, H. S., & Pickkers, P. (2011). The effects of implementation of the surviving sepsis campaign in the Netherlands. Netherlands Journal of Medicine, 69(6), 292-298.

The problem is that no sepsis bundles exists for the identification and treatment of septic patients on medical surgical units.

Purpose

The purpose of this pilot study is to develop and implement a severe sepsis bundle on a medical surgical unit to determine if there is a reduction in hospital length of stay and transfer to higher level of care.

Objectives

Generate administration and management support for the project

Educate medical surgical nurses on the topic of sepsis

Develop and implement a severe sepsis bundle (Tool, Algorithm, Order Set) for medical surgical units

Evaluate the sensitivity and specificity of a severe sepsis screening tool

Decrease septic patients hospital length of

stay.

Decrease septic patients transfer to higher level

of care.

Jorge Hirigoyen ARNP-BC

Efficacy of the Implementation of Early Severe Sepsis Strategies

on a Medical Surgical Unit

Theoretical Framework

Algorithm

Phases

Significance to Nursing

Results