Article

Development and implementation of a multidisciplinary sepsis protocol

Beth Israel Deaconess Medical Center, Boston, Mass., USA.
Critical Care Nurse (Impact Factor: 1.56). 07/2006; 26(3):43-54.
Source: PubMed

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    • "These institutions have published their protocol resources on the Internet (see Box 6), providing a useful information pool. Groups also have published aspects of their protocols in the medical literature [10] [12] [45]. Examples of generalized protocols applicable to implementing the SSC sepsis resuscitation bundle also are provided in this article (Figs. 7 and 8). "
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    ABSTRACT: Sepsis is a significant problem, and septicemia is the 10th leading cause of death in the United States. Sepsis incidence is increasing, and the mortality rate is 20% to 50% for patients with severe sepsis. This article identifies methods for improving outcomes of severe sepsis and septic shock. Included are recommendations for diagnosis and treatment. Case studies are included.
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    ABSTRACT: Nurses play a large role in preventing or minimizing errors in the health care system including crisis intervention and managing unexpected events daily. The actions and behaviors of the nurse in a deteriorating clinical situation can have an immediate impact on the patient and may be the key to understanding why some patients do well and others experience complications during the course of their care. Capacity to rescue is a new concept in nursing. Capacity to rescue is defined as the enactment of behaviors which allow for the optimization of patient outcomes, prevention of adverse events or reduction in the impact of an adverse event through early identification and timely interventions. The capacity to rescue conceptual model was developed and its components (work environment, nurse characteristics, nurse competencies) and their relationships were then defined. The Capacity to Rescue Instrument (CRI) was developed. It is a 22 item instrument used with a clinical simulation scenario to measure the nurse’s capacity to rescue. The clinical simulation measured the patient’s outcome in the specific condition used in the simulation scenario. The CRI instrument underwent validity and reliability testing. Factor analysis reduced the instrument from 36 to 22 items. Construct validity demonstrated a significant and positive relationship between capacity to rescue and outcomes (r=.772, p<.01) and the reliability coefficient was ά=.69. In addition to the CRI measure, several other measures were used as well. These included the Psychological Empowerment Instrument (1995), the Error Orientation Questionnaire (1999) and the Watson Glaser Critical Thinking Appraisal (2006). Data were gathered on 78 critical care nurses. Hypotheses testing on the conceptual model showed mixed results. No significant relationships were found between the predictors (empowerment, error orientation, critical thinking) and capacity to rescue. A significant relationship was found between capacity to rescue and patient outcomes related to the condition (p < .01) and the regression analysis showed the predictor variables (capacity to rescue, risk taking, critical thinking) explained 60% of the variance. Although findings did not show significant relationships between all predictor variables and capacity to rescue, the relationship between capacity to rescue and patient outcomes holds promise. Ph.D. Nursing University of Michigan, Horace H. Rackham School of Graduate Studies http://deepblue.lib.umich.edu/bitstream/2027.42/60718/1/mabersol_1.pdf
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