Date of Award

5-2-2016

Degree Type

Evidence-Based Project Report

Degree Name

Doctor of Nursing Practice (DNP)

Department

Nursing

First Advisor

Suzanne E. Zentz

Abstract

Sepsis is a serious concern of key healthcare stakeholders due to high incidence, mortality, and cost. The objectives of this evidence-based project were to 1) identify potential sepsis patients early during the emergency department (ED) triage process and 2) implement Sepsis Order Sets. Kotter’s change model and the Stetler model of evidence-based practice guided this project. An extensive literature search was undertaken to find best practice evidence regarding care of sepsis patients. Recommended care includes a protocolized format utilizing a screening tool and point of care lactate levels for early identification of sepsis, and early treatment with antibiotics and fluid resuscitation. A sepsis policy was developed based on recommended care. Education of the ED staff was accomplished. During the implementation period, EHRs of all ED triage patients >18 years of age were monitored to measure staff compliance with policy components. A chi square test of independence was calculated comparing screening rates pre and post policy implementation. A significant interaction was found (X2(1) = 438.505, p<.001. Patients were more likely to be screened post policy implementation than pre implementation. Staff compliance with Sepsis Order Sets was also analyzed for the post implementation group and increased compliance with all components was demonstrated. Secondary outcomes of the post implementation group included a length of stay of 7.7 days and a mortality rate of 11.11%. EHRs of patients who were discharged with a sepsis diagnoses during the implementation period were further analyzed. An odds ratio was calculated and illustrated that patients who were screened were 34% less likely to die when compared to patients who were not screened. Results demonstrate that implementation of a sepsis policy that includes a computer based screening tool and point of care lactate significantly impacts early identification of sepsis patients, and leads to timely treatment with subsequent decreased length of stay and mortality. These findings can be used to change current practice in both emergency department settings and in-patient units.

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