Establishing an Emergency Department Sepsis Screen Phelan Bailey, RN, CEN Emergency Department Nurse Manager St. Claire Regional Medical Center Kentucky
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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
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
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
Discovering a Need Chart reviews of patients with primary diagnosis of sepsis for the months of January- March 2012. 42 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
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.
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
Post-Intervention Data Screening initiated on January 15 th, 2013. 235 positive screens from January 15 th,2013 through June 30 th, 2013. 113 (48% of patients with positive screen) met criteria for diagnosis of sepsis. Main sources: Sepsis of urinary origin. Sepsis of pulmonary origin. 9
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
QUESTIONS? 11
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