Development and implementation of a multidisciplinary sepsis protocol

ArticleinCritical Care Nurse 26(3):43-54 · July 2006with24 Reads
Source: PubMed
    • "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). "
    [Show abstract] [Hide abstract] 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.
    Full-text · Article · Jul 2008
  • Article · · Critical Care Clinics
  • [Show abstract] [Hide abstract] ABSTRACT: The emergency department at John Muir Concord campus has implemented a Sepsis Early Goal Directed Therapy (EGDT) protocol based on the guidelines put forth by the international Surviving Sepsis Campaign. Evidence-based practice clearly identifies that the initiation of the sepsis EGDT in the emergency department improves morbidity and mortality (Osborn, Nguyen, & Rivers, 2005). Despite this evidence, the protocol is inconsistently and inaccurately used in the emergency department. The goal of this project is to improve the implementation of the sepsis EGDT protocol through education, empowerment and advocacy. The target population is the registered nurses currently and actively employed in the emergency department. A needs assessment was performed to ascertain why the protocol was not consistently or accurately used. Results from the needs assessment discovered that the nurses were not comfortable using the EGDT protocol. However, the majority of the nurses felt using the EGDT protocol was extremely relevant to nursing practice. Once there was an understanding of where the dearth of education was, a two-part intervention was initiated. Phase I included a short staff in-service outlining the EGDT protocol. The goal of the phase I education was to highlight the portions of the protocol that received low scores on the needs assessment. As a result, the educational intervention focused on central venous pressure (CVP), central venous oxygen saturation (ScVO 2), and the medications used to manage hemodynamics. Phase II of the project is to be strategically initiated during the month of November, due to the increase in the number of septic patients presenting to the ED. Phase II includes hands on manipulation of the CVP and ScVO 2 equipment. Case studies will be used in conjunction with the hands on manipulation to reinforce the education. Multiple challenges emerged as phase I was implemented. The timing of the educational intervention was difficult to schedule due to the rotating schedules of staff nurses. The main challenge to phase I implementation was nurse resistance to change in practice. As phase II is implemented, one of the main obstacles to overcome will be changing the perceived barriers held by the staff nurses. Results from phase I indicated that the nurses continue to feel uncomfortable using the sepsis EGDT protocol. However, the results indicated there was an improvement regarding understanding CVP and ScVO 2 monitoring. The next steps to this project involve reinforcing the understanding of CVP and ScVO 2 monitoring as well as improving nurse comfort level regarding the use of the sepsis EGDT protocol.. Surviving sepsis campaign guidelines for management of server sepsis and septic shock.. Emergency medicine and the surviving sepsis campaign: An international approach to managing severe sepsis and septic shock.
    Article · · Critical Care Clinics
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