| Primary Author: | Kelly Marie Nguyen, RN, BSN |
| Co-Principal Investigators/Collaborators: | Joan Santana |
| Organization: | El Camino Hospital |
Abstract
Background
In the United States there are over 600,000 patients admitted through the emergency department (ED) with sepsis. Current publications demonstrate that survival for these patients is dependent upon prompt recognition and timely implementation of Early Goal-Directed Therapy (EGDT). However, existing literature is limited in detailing the key role the registered nurse (RN) has in the identification of sepsis and the delivery of EGDT.
Purpose
This project looked at the role of the RN in team care to initiate, coordinate, collaborate and identify the necessary steps to improve patient outcomes for best practice sepsis treatment. Nurses with knowledge in best evidence based practice sepsis care, identified strategies to be instrumental in transforming that into implementation of preventive and appropriate action.
Materials & Methods
EGDT was bundled into a standardized procedure. RNs were empowered to screen patients for sepsis, initiate the protocol and implement the standardized procedure for patients that screened positive. RNs were also encouraged to collaborate with physicians regarding the implementation of EGDT. Pre/post measurements were taken for the components of EGDT: lactate, blood cultures (drawn before antibiotic administration), isotonic fluid bolus(es) and administration of an antibiotic within thirty minutes of patient arrival.
Results
Compliance rates for each aspect of the EGDT bundle improved. Additionally, strengthening collaborative practices with emergency department and critical care unit physicians yielded an increase in central line placement and enhanced the use of EGDT therapies. A significant decrease in the mortality rate for patients with severe sepsis and septic shock resulted.
Conclusion
RNs are vital to improving sepsis mortality rates through prompt recognition and initiation of EGDT. RNs are instrumental in providing a collaborative means to support the application of appropriate therapies for patients with sepsis; and are key players in coordinating the delivery of care required for this patient population. Closing the gap between knowledge and practice produces outcomes that reinforce positive continued nursing and team performance to save lives in sepsis care.
© Improvement Science Research Network, 2011