assignment

Search Method:

An extensive literature search for the most pertinent best practice evidence on providing care for the sepsis Patient was conducted, utilizing the following search engines; a) Cochrane Library, b) Cumulative Index to Nursing and Allied Health (CINAHL) via Grand Canyon University (GCU) Fleming Library, d) Proquest via GCU Fleming Library, e) Pubmed via National Center for Biotechnology (NCBI). The key words that were searched were categorized into three groups: a) by disease- utilizing, sepsis, septic and severe sepsis, b) Interventions utilizing, early identification, diagnosis, alert, guidelines, bundles, protocols, c) population utilizing, emergency room, emergency department, ED, ER all terms were consistently used throughout the data bases to ensure search consistency.

Inclusion/Exclusion Criteria:

Inclusion criteria included peer-reviewed articles, scholarly articles published in the English language with publications dated 2012 or later. Articles pertaining to adult patient population, with focus on early identification, diagnosis and treatment of sepsis patients in the Emergency department, identified or initiated performance improvement or other protocols with included interventions consistent with recommendations in the 2012 Surviving Sepsis Guidelines, or discussed barriers to implementing sepsis protocols in the Emergency department.

Exclusion criteria included articles that focused on the advanced care of sepsis patients in intensive care units, focus on obstetric patients or pediatric patients, focused on guidelines written prior to 2012, and most articles published before 2012.

Search results returned 10 articles, Cochrane Library returned not evidence meeting criteria, CINAHL returned 22 articles, Proquest returned 16 articles (after the removal of duplicates) 38 articles were reviewed and 10 articles were included. All studies included were appraised following the hierarchy of evidence, the majority of studies are level II as they are randomized control trials, or cohort studies, one level I systematic review and Meta-analysis study as well as one nonexperimental study and Clinical Practice Guidelines.

Summary of Research

Limitations of Research studies

Limitations include some studies lacked generalizability, due to being single site, retrospective studies that the original information was not documented for the purpose of the study. One study although information was collected and documented for the study only a single site was included in the study. One study all the included studies were observational investigations and cannot support connection between performance improvement, increase in bundle compliance and decrease in patient mortality with uncomplicated septic shock or severe sepsis.

External validity as well generalizability of the different versions of protocols and resuscitation bundles was established. Patient populations of studies were representative of the adult emergency department patient population. The patient populations and data collected was typical of emergency department adult sepsis patient. Goal- directed therapy and protocols early was shown to decrease cost of care, significantly reduce mortality, and increase clinician adherence to clinical guidelines and modification of clinician behavior associated with identification of the sepsis patient.

References