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The purpose of this project was to facilitate early recognition of signs and symptoms of sepsis through utilization of a sepsis screening tool along with education of staff nurses on medical-surgical units in two acute care hospitals.
The incidence of hospital admissions with primary or secondary diagnoses of septicemia doubled from 2000 to 2009; patients with sepsis tend to be sicker and have longer admissions, and are more likely to be discharged to long-term care facilities than to home (Elixhauser, Friedman, & Stranges, 2011). Sepsis mortality is estimated at one in four patients, with risk increasing as the disease advances (Dellinger et al., 2013).
Of patients who experience sepsis or septic shock, almost one-quarter develop it while hospitalized on medical-surgical units (Tazbir, 2012), yet less than 40% of medicalsurgical nurses are able to recognize sepsis in their patients (Moore & Moore, 2012). The risk of mortality tends to be higher for patients diagnosed with sepsis while on general inpatient units compared to intensive care or emergency settings (Levy et al., 2010). Research demonstrated patients exhibit changes in physiologic parameters as early as 8 hours before adverse events; patients' survival thus depends on nurses' ability to recognize signs and symptoms of sepsis and communicate their observations to providers (Mapp, Davis, & Krowchuk, 2013). The Surviving Sepsis Campaign (SSC) guidelines recommended routine screening of acutely ill patients for early identification of sepsis and early commencement of goal-directed therapy to increase chance of survival and improve patient outcomes (Dellinger et al., 2013).
Project Site and Reason to Change
Two hospitals in northern New Jersey were selected as project sites. One medical-surgical unit was identified at each facility based on similarity of patient population and acuity. No nurse-driven sepsis screening was performed on the units, but patients were known to exhibit signs of sepsis for over 24 hours before a provider was notified.
Program
Phase 1: Identify Problem. Identify, Review, and Select Knowledge.
A 15-question nurse survey revealed gaps in knowledge of sepsis symptoms and progression. Questions were derived from the 2015 World Sepsis Day (n.d.) educational assessment and relevant clinical scenarios. The pre-survey was completed by 34 of 44 nurses (77.3%) at Hospital 1 and 17 of 28 nurses (63.5%) at Hospital 2. The average percentage of...