Abstract
Poster presentation
Session I presented Wednesday, October 2, 10:00-11:00 am
Purpose: Sepsis continues to account globally for eight million deaths annually. The emergency department (ED) is a key entry point where many patients present with SIRS/severe sepsis/septic shock symptoms. There is a nationwide effort in improving recognizing and completing the three hour CMS bundle within the time limits in the ED in order to deliver best practice for this high mortality diagnosis. A large urban academic institution introduced a sepsis bedside tool using the 2016 CMS criteria to promote immediate triage, recognition and treatment of patients with suspected sepsis. The objective of this project was to increase bundle compliance.
Design: This is a quality improvement project of the ED sepsis three hour bundle compliance pre and post implementation of the bedside sepsis tool.
Setting: The project was implemented in an urban academic hospital ED that sees approximately 100K patients annually.
Participants/Subjects: Inclusion criteria included two or more SIRS symptoms with a suspected infection. Initial Lactate >18mg/dl (2mmol/L). Exclusion criteria Initial lactate < 18mg/dl (2mmol/L.
Methods: Data was collected and compared for three months pre and post implementation of the bedside sepsis tool. Bedside tool collected data points included: IV access time, initial lactate time, initial blood culture time, second blood culture time, time of administration of antibiotics, and repeat lactate time.
Results/Outcomes: Collection of data pre and post implementation of the bedside sepsis tool indicated that there was an increase in meeting the bundle completion time within three hours of arrival to the ED compared to the pre-implementation data. Initial lactate drawn within 60 minutes of ED arrival Pre/Post- 53%/73%. First blood culture drawn within 60 minutes of arrival time 44%/67% , antibiotic administered within 180 minutes 44%/67%, repeat Lactate drawn within 360 minutes 60%/78%, IV access with in 15 minutes 4%/38%, second blood culture within 90 minutes 71%/49%.
Implications: Use of the Sepsis Bedside Tool by emergency practitioners increased the three hour bundle compliance by an average of 20%. This bedside tool did reduce the time taken for specific treatment to be started; however, there is still room for improving performance compliance. Recommendations/Next Steps : The bedside tool was revised to separate out the three and six hour bundles and to collect the current CMS standards. The tool was also revised to include a mandatory "bedside huddle" between the physician and nursing. Additionally, sepsis champion RNs in the ED have also been implemented. Data collection is currently ongoing.
Sigma Membership
Non-member
Type
Poster
Format Type
Text-based Document
Study Design/Type
N/A
Research Approach
N/A
Keywords:
Sepsis, Tool, Emergency
Recommended Citation
Cleary, Carla, "Using a sepsis bedside form in the emergency department" (2020). General Submissions: Presenations (Oral and Poster). 105.
https://www.sigmarepository.org/gen_sub_presentations/2019/posters/105
Conference Name
Emergency Nursing 2019
Conference Host
Emergency Nurses Association
Conference Location
Austin, Texas, USA
Conference Year
2019
Rights Holder
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Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Using a sepsis bedside form in the emergency department
Austin, Texas, USA
Poster presentation
Session I presented Wednesday, October 2, 10:00-11:00 am
Purpose: Sepsis continues to account globally for eight million deaths annually. The emergency department (ED) is a key entry point where many patients present with SIRS/severe sepsis/septic shock symptoms. There is a nationwide effort in improving recognizing and completing the three hour CMS bundle within the time limits in the ED in order to deliver best practice for this high mortality diagnosis. A large urban academic institution introduced a sepsis bedside tool using the 2016 CMS criteria to promote immediate triage, recognition and treatment of patients with suspected sepsis. The objective of this project was to increase bundle compliance.
Design: This is a quality improvement project of the ED sepsis three hour bundle compliance pre and post implementation of the bedside sepsis tool.
Setting: The project was implemented in an urban academic hospital ED that sees approximately 100K patients annually.
Participants/Subjects: Inclusion criteria included two or more SIRS symptoms with a suspected infection. Initial Lactate >18mg/dl (2mmol/L). Exclusion criteria Initial lactate < 18mg/dl (2mmol/L.
Methods: Data was collected and compared for three months pre and post implementation of the bedside sepsis tool. Bedside tool collected data points included: IV access time, initial lactate time, initial blood culture time, second blood culture time, time of administration of antibiotics, and repeat lactate time.
Results/Outcomes: Collection of data pre and post implementation of the bedside sepsis tool indicated that there was an increase in meeting the bundle completion time within three hours of arrival to the ED compared to the pre-implementation data. Initial lactate drawn within 60 minutes of ED arrival Pre/Post- 53%/73%. First blood culture drawn within 60 minutes of arrival time 44%/67% , antibiotic administered within 180 minutes 44%/67%, repeat Lactate drawn within 360 minutes 60%/78%, IV access with in 15 minutes 4%/38%, second blood culture within 90 minutes 71%/49%.
Implications: Use of the Sepsis Bedside Tool by emergency practitioners increased the three hour bundle compliance by an average of 20%. This bedside tool did reduce the time taken for specific treatment to be started; however, there is still room for improving performance compliance. Recommendations/Next Steps : The bedside tool was revised to separate out the three and six hour bundles and to collect the current CMS standards. The tool was also revised to include a mandatory "bedside huddle" between the physician and nursing. Additionally, sepsis champion RNs in the ED have also been implemented. Data collection is currently ongoing.