Implementing a Nurse-Driven Clinical Decision Support Tool for Early Sepsis Recognition

Abstract

Purpose: This Doctor of Nursing Practice (DNP) project aims to increase early recognition of patients with sepsis or septic shock by implementing a nurse-driven clinical decision support tool in the Northern Cochise Community Hospital (NCCH) emergency department (ED). In addition, a secondary purpose of this project was to consolidate descriptive information about local patient population diagnosed with sepsis, to give NCCH a better understanding of the scope of problem. Background: Sepsis is a clinical syndrome caused by an infection that becomes dysregulated host response resulting in organ dysfunction (The Society of Critical Care Medicine [SCCM], 2017, 2021). The Centers for Disease Control and Prevention (CDC) data indicates that approximately 1.7 million adults in America develop sepsis each year. Nearly 270,000 die from it, which is approximately 1 in 3 patients. Health care expenditures related to sepsis totaled $23.7 billion in 2013 (CDC, 2016, 2019). Methods: The method that guided this DNP project was FOCUS - Plan-Do-Check-Act (PDCA) four-cycle model to problem-solve for early sepsis recognition. The FOCUS process helped the sepsis team to identify root causes by analyzing acts from a retrospective chart review, pre-intervention. PDSA cycle allowed for a rapid assessment for changes and/or adjustments as needed, post-intervention. Results: In total, a pre-intervention retrospective charts review was conducted, yielding 1,648 charts. After exclusions, a total of 32 patients’ charts in 2020 and 45 charts in 2021 were used for this quality improvement (QI) project. These charts met SIRS/Sepsis criteria with and suspected infection(s) that missed a sepsis diagnosis. Unfortunately, many charts lacked follow-up vital signs, and providers did not complete full work-up for a more accurate inclusion count. Conclusions: QI project purpose was to increase early sepsis recognition at NCCH ED using nurse-driven CDST, and to consolidate descriptive information about local patient population diagnosed with sepsis, to give the NCCH better understanding of scope of the problem. A lot of rich data was obtained, and results were mixed, in large part due to constraints of COVID-19 pandemic, valuable insights were acquired and presented to NCCH management to be utilized in future nursing education and triage process in the ED.