Implementation of an In-House Sepsis Alert Process: The Magic Bullet

Purpose:
The Emergency Department and ICU collaborated to develop a Sepsis Alert Process to identify/treat sepsis. The process was expanded to identify the in-house patient that exhibits symptoms of sepsis. The nurse-driven model gives the nurse autonomy to assess, treat and transfer the patient to the ICU.

Significance:
84% of patients have signs of clinical deterioration 6-8 hours before the Rapid Response Team (RRT) is called or a cardiac arrest occurs. Early recognition of subtle changes in the patient's condition is the key to early identification/treatment of sepsis.

Strategy and Implementation:
Medical/Surgical staff nurses were educated regarding the signs/symptoms of sepsis. Critical Care nurses and physicians collaborated to develop a nurse-driven protocol to treat the septic patient. The staff nurse identifies changes in 3 or more vital signs, notifies the RRT nurse and patient's physician. The RRT nurse assesses the patient and implements interventions from the in-house sepsis protocol. The RRT and bedside nurses evaluate the patient's response to the interventions and have the autonomy to transfer the patient to ICU if appropriate. The physician is made aware of the patient's status and transfer. The RRT/bedside nurse duo plus protocol is the innovative, evidence-based approach translated to a different patient population.

Evaluation:
The process was implemented Dec., 2012. In-House Sepsis Alert outcomes have been positive. The RRT nurse electronically tracks RRT calls, reason, unit calling, interventions implemented, duration of the response, patient outcome. Data before and after implementation of the process were compared.

Implications for Practice:
Sepsis has a high mortality rate and is costly to treat. Early identification/treatment of the septic patient results in decreased mortality, length of stay, cost. Implementation of a nurse-driven, evidence-based protocol results in improved quality of care and positive patient outcomes.