Establishing an Emergency Department Sepsis Screen

Transcription

1 Establishing an Emergency Department Sepsis Screen Phelan Bailey, RN, CEN Emergency Department Nurse Manager St. Claire Regional Medical Center Kentucky

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3 About Us St. Claire Regional Medical Center is a 159-bed rural hospital centrally located between Lexington and Ashland, in Morehead, Kentucky. The emergency department has approximately 30,000 yearly visits, which accounts for for more than 70% of the admissions to the hospital. Nursing and physician leaders in the emergency department work closely together to advance the care of patients. 3

4 Case Study 62 year old male presenting from long-term care facility paraplegic, bed-ridden indwelling urinary catheter. Complaint: deteriorating mental status. Vital signs: blood pressure 80/50, heart rate 119, respiratory rate 23, temperature 98.5 C, spo 2 95% on 2 liters per minute via nasal cannula. Treatment is initiated. 4

5 Case Study (cont.) The patient remains in emergency department for several hours with limited IV fluids and a single antibiotic agent administered. The patient is admitted to the ICU and received a central line, arterial line, several boluses of IV fluids, additional antibiotics, and vasopressors. Why weren t these interventions initiated in the emergency department? 5

6 Discovering a Need Chart reviews of patients with primary diagnosis of sepsis for the months of January- March patients with primary diagnosis of sepsis. 21 patients met SIRS criteria at triage 13 of those 21 patients met SIRS criteria based on vital signs alone. Only 3 of those 21 patients had the established sepsis order set initiated. 6

7 The Next Step Sepsis screening tool created and added into ED triage assessment. Performed on every adult patient upon arrival to emergency department. If patient meets the criteria, the Triage Sepsis order set is initiated by the nurse and the patient is flagged on the tracker.

8 Triage Sepsis Order Set CBC CMP Magnesium PTT, PT/INR Lactate Troponin BNP Blood culture x 2 Includes the following: UAMC CXR - portable EKG IV initiation and normal saline bolus Bedside telemetry, noninvasive blood pressure, and continuous pulse oximetry monitoring

9 Post-Intervention Data Screening initiated on January 15 th, positive screens from January 15 th,2013 through June 30 th, (48% of patients with positive screen) met criteria for diagnosis of sepsis. Main sources: Sepsis of urinary origin. Sepsis of pulmonary origin. 9

10 What s Next? Establishment of sepsis risk screening for inpatient units. Sepsis education for all nursing staff. Development of protocols to decrease the risk of developing sources of infection: Criteria for indwelling catheter insertion to decreased incidence of catheter-associated urinary tract infections (CAUTIs). Ventilator-associated pneumonia (VAP) prevention. 10

11 QUESTIONS? 11

12 Template Format and 508 Compliance Guidelines The following slides highlight the HRET template format, and tips for ensuring slides are 508 compliant. Please DELETE when the final presentation is created. THANK YOU! 12

13 508 Compliance Requirement A Note to the Author This presentation is being developed for the Hospital Engagement Network (HEN) Project, a federally funded project, and therefore is required to be in compliance with section 508 of the Rehabilitation Act. Section 508 requires Federal departments and contractors providing services or products to Federal Agencies to provide Section 508 compliant deliverables. Read more from the government website: As participants of the HEN project we are required to develop and maintain our presentations in a way that ensures members of the public with disabilities have access to these presentation in a way that is comparable to that of the members of the public without disabilities. Please note that while this template is currently 508 compliant as it stands, the information you add to your presentation must be made 508 compliant. The following slide provides you with a few tips for making the information you add to this template 508 compliant. (Please remove this slide from your final presentation)

14 508 Compliance Checklist Components of a 508 Compliant PPT Document: All text must show up on the Outline Tab Use the template slides and the slide layout option for adding content and do not insert text boxes Full URLs should be listed and active Avoid Slide Transitions and Animation Make sure there is significant color contrast (e.g. light background and dark text or dark background and light text) Include Alt tags (Alternative Text) for all images, shapes, and charts Include Labels for all tables, charts, or graphs (e.g. chart title, axis title, row titles) Make sure slide content is arranged or stacked correctly so a screen reader will read information in the correct order Provide videos separately from the presentation in their native format (e.g..wmv), and provide a transcript for the video if possible (for captioning) Make all text 18pt or larger Avoid the use of text effects (e.g. text shadow) (Please remove this slide from your final presentation)