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7 Translating sepsis research to improve outcomes in obstetrical and gynecological patients

Monday, February 11, 2013
Patricia R Johnson, DNP, RN, CNEA-BC , Nursing Administration, Woman's Hospital, Baton Rouge, LA
Sue A Neumann, MS, RNC, CPHRM , Nursing Administration, Woman's Hospital, Baton Rouge, LA
Lisa S Lee, BS, RN , Nursing Administration, Woman's Hospital, Baton Rouge, LA
Cheri Johnson, BSN, RNC-OB , Nursing Administration, Woman's Hospital, Baton Rouge, LA
Fancy Manton, Pharm.D., BS, RPh , Pharmacy, Womans Hospital, Baton Rouge, LA
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Purpose:
The goal of this project is to reduce maternal death with the early identification of sepsis and implementation of evidence based interventions. The Institute of Medicine Aims are used as a structure for evidence-based systems change developed after three maternal deaths from sepsis.

Background/Significance:
Maternal mortality is considered an indicator in overall population health. Perinatal sepsis is the cause for 13% of maternal deaths worldwide, and approximately three deaths per 100,000 births in the US. The mortality rate from sepsis is estimated to be 30-40% and from septic shock it is 50-60%. Early appropriate treatment within the first hours a patient presents with symptoms is associated with improved outcomes. The key to decreased sepsis mortality is early detection and treatment.

Methods:
The design is a retrospective chart review of adult patients who received blood cultures in the assessment center, or who were admitted with a diagnosis of sepsis. The review included components of the IHI sepsis bundle: timeliness of antibiotic administration, serum lactate measurements, placement of a central venous line, blood cultures, and fluid administration. Data collection focused on the use of a sepsis screening tool, sepsis protocols, timing of antibiotic administration, timing of blood cultures, and serum lactate tests. Outcomes measures included AICU admissions, hospital transfers, length of stay, and deaths of patients with sepsis diagnosis.

Results:
Data collection occured over a four month period, after the formation of a multidisciplinary taskforce, education about sepsis, participation in an IHI sepsis webinar, development of a sepsis screening tool, development and implementation of sepsis protocols based on the Surviving Sepsis Campaign, and use of the plan-do-study-act methodology of performance improvement. System processes were revised each month following a review of data at the taskforce meeting. Findings include an increase in the healthcare teams knowledge and utilization of the sever sepsis criteria, and use of a screening tool resulted in an increase in early identfication and treatment of patients with sepsis.

Conclusions and Implications for Practice:
The implementation of education,screening tool, protocols, and measurement of the IHI sepsis bundles did improve early identification and treatment for obstetrical patients with sepsis. Practice implications include the transfer of knowledge from other spheres of practice to obstetrical nursing.

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