Improving the early identification and management of sepsis: Successful implementation of an evidence-based screening and treatment pathway at Eastern Health

Miss Meredith Symons1, Mrs Andrea  Doric1, Mr Chris Jackson1, Mr Dan Neale1, Dr Hussein Alabodi1

1Box Hill Hospital, Eastern Health, Melbourne, Australia

Introduction: Sepsis is a medical emergency. Research shows that early recognition of sepsis and timely administration of antibiotics can improve patient outcomes and reduce mortality. Performance monitoring identified sepsis as a high prevalence condition contributing to episodes of clinical deterioration in our organisation.

Study Objectives: Enhance sepsis recognition

  • Ensure timely appropriate sepsis management
  • Reduce mortality, morbidity and length of stay from sepsis

Methods: In July 2015, the Improving Sepsis Recognition and Management program was implemented at Eastern Health,  including:

  • A sepsis screening tool
  • An evidence-based sepsis pathway
  • Alignment of antibiotic prescribing guidelines to evidence
  • A sepsis pathology order set
  • Education sessions for clinical staff

Following on from the initial rollout, locally led gains were further enhanced in the ED through participation in the Emergency Care Clinical Network (ECCN) 2016 evidence-based quality improvement sepsis project which included:

  • Raising staff awareness through education, lanyards, posters and regular feedback of audit data
  • Collaboration with pharmacy, antibiotic stewardship, clinical deterioration committee
  • Celebrating World Sepsis Day
  • Holding a Sepsis Screening Challenge

Results: Results pre- and post-ECCN project were significant with key outcomes as follows:

  • Sepsis identified at triage or first nursing contact – increased from 11% to 21%
  • Intravenous antibiotics given within one hour of ED presentation – increased from 11% to 42%
  • Intravenous fluids commenced within one hour of ED presentation – increased from 44% to 63%
  • Serum lactate measured – increased from 78% to 89%
  • Hospital length of stay decreased from 9.5 to 6.0 days for patients presenting to ED with sepsis

Conclusion: The introduction of the sepsis pathway has enhanced clinician capability, improved resilience and is contributing to better patient outcomes. Importantly, providing data showing improvements helps to engage staff to change their practice.


Biography:

Meredith is an Emergency Clinical Nurse Specialist at Box HIll Hospital with a particular interest in quality improvement and safety in the ED.  She has previously presented an initiative to prevent blood transfusion errors at ICEN 2014.  Meredith is currently completing a Masters of Advanced Nursing Practice with the goal of attaining endorsement as an Emergency Nurse Practitioner.