Text

theses

PURPOSE: Early identification of septic patients is important for early treatment, reduction of length of stay and mortality, and reduction of costs. Early identification processes should leverage functionality of the electronic medical record to automate identification and notification to healthcare providers in order to reassess the patient and start treatment if necessary. A community hospital in Northern New Jersey implemented an electronic sepsis surveillance board that automatically qualified patients based on SIRS criteria in 2015, but had not completed any analysis surrounding the surveillance board or the process. Once qualified, the primary nurse is to take a second set of vital signs and the rapid response nurse is to evaluate the patient to determine if further interventions are necessary. The purpose of this project was to evaluate the compliance surrounding the process for an electronic sepsis surveillance board.

METHODOLOGY: A retrospective, closed chart review was completed for patients that qualified between January 1st, 2017 to June 30th, 2018 in six medical/surgical and two cardiac/telemetry units. An analytics tool was used to create the analysis regarding compliance for obtaining a second set of vital signs, rapid response team interventions, and overall qualification reasons and time on the electronic sepsis surveillance board.

RESULTS: During the analysis period, 3,491 patients (n=3,491) qualified on the electronic sepsis surveillance board, totaling of 9,602 qualifications and 2.3 average number of qualifications per patient. Patients were on the electronic sepsis surveillance board for an average of 196.6 minutes. Overall compliance to documentation of the required second set of vital signs was 71.4%, with a mean time to documentation at 8 hours 1 minute. False positives were not able to be analyzed due to the length of time to obtain a full set of vital signs. Overall compliance to documentation by the rapid response team was 35.4%, with the mean time to documentation of 1 hour 7 minutes, with higher compliance to documentation during the day shift.

IMPLICATIONS FOR PRACTICE: This project supports the need for continued analysis regarding the process surrounding early identification and treatment of potentially septic patients. Without the analysis, the organization would not have identified that there was not a policy defining the process, that a full set of vital signs was not being documented in the defined period, and that documentation was not occurring in real time. Reinforcement needs to be done regarding timely assessment of patients. Technology needs to be evaluated on how it can assist staff in obtaining real time documentation and alerting of potentially septic patients. The organization must also create ways to share compliance rates with staff in order to increase awareness and improve compliance with the process. Implications for future research include analysis on patient outcomes once the time to documentation is reduced.

ETD_9550

doi:10.7282/t3-3605-1z76

DNP

Includes bibliographical references

ETD doctoral

The author owns the copyright to this work.