Early Recognition of Sepsis; Beyond the ICU/ED, Taking it to the Acute Care Floors

Purpose:
Healthcare facilities are challenged with implementation of the 2008 Surviving Sepsis Campaign Guidelines (SSC). The greatest improvement in outcomes can be made through staff education and process changes in the non-ICU setting.

Significance:
Sepsis is the 10th leading cause of death with 500 patients dying daily in the US. Benefits of a standardized approach to the management of sepsis are noted as decreased mortality, length of stay, and financial cost to the institution.

Strategy and Implementation:
Research suggests that early recognition and implementation of key strategies within the first six hours are critical to positive outcomes. Phase 1: Sepsis protocol was developed and implemented in the ICUs. Education was provided to ICU and ED. Data collected and analyzed; positive outcomes realized. Phase 2: Sepsis protocol revised to support 2008 SSC guidelines, focusing on early recognition and implementation of first six-hour bundle. Education provided to RNs in the acute care setting and to MDs who practice outside the ICU setting. Rapid Turnaround Unit (RTU) initiated to support RNs with requisite increased interventions. Positive outcome results post-implementation realized. Phase 3: Continue strategies. Develop sepsis resource RNs to provide education, data collection, and achieve sustainability through enforcing compliance with sepsis protocol. Consider expansion of the Rapid Response Team. Consider role of Rapid Turnaround Unit.

Evaluation:
Phase 1:Post-implementation data demonstrated statistically significant decreases in each indicator: Mortality, Ventilator Days, LOS, ICU LOS, Total cost. Phase 2:RTU pilot underway. Sepsis Protocol was revised and education completed. Results for the 2009 YTD show continued improvements.

Implications for Practice:
Implementation of a Sepsis Protocol house wide improves outcomes. Organizational support provides acute care RNs the assistance to balance their patient load while caring for the newly recognized septic patient. Further defined roles of the RTU and rapid response team are indicated.