The Effects of Implementing the N-PASS Care Bundle on the Incidence of Acute Kidney Injury and Clinical Outcomes in Patients with Sepsis and Septic Shock within an Internal Medicine Department
Abstract
This quasi-experimental study utilized a non-randomized, post-test-only control group design to investigate the effects of the N-PASS (Nursing Care Bundle to Prevent Acute Kidney Injury among Patients with Sepsis and Septic Shock) care bundle on the incidence of acute kidney injury (AKI) and clinical outcomes in patients with sepsis and septic shock admitted to the internal medicine department of a tertiary hospital in Northeastern Thailand between April and July 2023. Eighty inpatients were assigned to either the control group (n = 40), which received standard hospital care, or the experimental group (n=40), which received care based on the N-PASS bundle. The N-PASS care bundle is an innovative nursing intervention developed based on established nursing guidelines for AKI prevention in patients with sepsis and septic shock. Data were analyzed using descriptive statistics, Cox Proportional Hazard Regression, independent t-tests, repeated measures ANOVA, and the Mann-Whitney U test. The following results were observed.
1. The incidence rate of AKI in the experimental group was 17.24 cases per 1,000 patient-days, compared to 515.63 cases per 1,000 patient-days in the control group. Patients in the control group had a 16.5 times higher risk of developing AKI than those in the experimental group (HR = 16.5, 95% CI [4.24, 64.18], p-value < .001). The experimental group had significantly lower mean serum creatinine levels at baseline (p-value = .002) and at 48 hours (p-value =.016). Mean urine output was significantly greater in the experimental group at 6 hours (p-value < .001) and 72 hours (p-value < .001). The Shock Index was significantly lower in the experimental group at baseline (p-value = .002), 3 hours (p-value < .001), 24 hours (p-value < .001), and 72 hours (p-value = .001). Mean serum lactate levels were significantly lower in the experimental group at baseline (p-value = .005) and 24 hours (p-value < .001). Mean Arterial Pressure (MAP) was s significantly higher in the experimental group at baseline (p-value < .001) and at 3 hours (p-value = .001).
2. Regarding nurses’ compliance and satisfaction, 100% of nurses adhered to the N-PASS care bundle, and 98.4% reported satisfaction with using the bundle.
This study suggests that the N-PASS care bundle is effective in reducing the incidence of AKI and improving clinical outcomes in patients with sepsis and septic shock. High nurse compliance and satisfaction with the N-PASS bundle indicate its feasibility for implementation in real-world clinical settings.
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