Outcome of development of The Lerdsin Hospital Sepsis Protocol Checklist


  • Nittaya Puripan Lerdsin Hospital , Bangkok, Thailand
  • Amnarj Katsakun Lerdsin Hospital , Bangkok, Thailand
  • Nattawan Palavutitotai Lerdsin Hospital , Bangkok, Thailand


sepsis, septic shock, protocol, best practices


     This descriptive cross-sectional study aimed to investigate the outcome of the nursing care system before and after the development of Lerdsin Hospital Sepsis Protocol Checklist for sepsis patients in the emergency department. Methodology: the participants included 140 patients aged 15 years and above with a diagnosis of sepsis. The participants were assigned to two groups. Seventy patients participated in the study without the application of the protocol. The other 70 patients participated in the protocol applied using the Lerdsin Hospital Sepsis Protocol Checklist with complete data. Patients were randomly assigned into 2 groups. Intention-to-treat analysis was used to describe data from all participants randomized to protocol. Data were analyzed using descriptive statistics. Chi-square test was used to compare mean
difference. Significant level was set at p < .05.
     Results showed the improvement in all nursing care processes in sepsis patient after using application of the sepsis protocol checklist (p< .05, p< .001). The number of patients with good clinical outcomes that could be discharged from hospital was significantly increased from 58.6% to
82.9%, and the mortality rate waned from 41.4% to 17.1% p< .05). However, length of hospital stay
was not statistically significantly reduced (p = .146).


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1. Moreno R, Vincent J-L, Matos R, Mendonca A, Cantraine F, Thijs L, et al. The use of maximum SOFA score to quantify organ dysfunction/failure in intensive care. Results of a prospective, multicentrestudy. Intensive Care Med. 1999;25(7):686–96.

2. Song Y, Shin T, Jo I, Jeong Y, Kang M, Sim M, et al. 54 Predicting factors associated with clinical deterioration of sepsis patients with intermediate levels of serum lactate. Ann Emerg Med. 2012;4(60):S21–2.

3. Vosylius S, Sipylaite J, Ivaskevicius J. Sequential organ failure assessment score as the determinant of outcome for patients with severe sepsis. Croat Med J. 2004;45(6):715–20.

4. Huang DT, Clermont G, Dremsizov TT, Angus DC, Investigators P. Implementation of early goal-directed therapy for severe sepsis and septic shock: a decision analysis. Crit Care Med. 2007;35(9):2090–100.

5. Martin GS, Mannino DM, Eaton S, Moss M. The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med. 2003;348(16):1546–54.

6. Finfer S, Bellomo R, Boyce N. A comparison of albumin and saline for fluid resuscitation in the intensive care unit. N Engl J Med. 2004;350(22):2247–56.

7. Pittet D, Rangel-Frausto S, Li N, Tarara D, Costigan M, Rempe L, et al. Systemic inflammatory response syndrome, sepsis, severe sepsis and septic shock: incidence, morbidities and outcomes in surgical ICU patients. Intensive Care Med. 1995;21(4):302–9.

8. Arise D. The outcome of patients with sepsis and septic shock presenting to emergency departments in Australia and New Zealand. Crit Care Resusc. 2007;9:8–18.

9. Angkasekwinai N, Rattanaumpawan P, Thamlikitkul V. Epidemiology of sepsis in Siriraj Hospital 2007. J Med Assoc Thai. 2009;92 (Suppl 2):S68-78. (in thai)

10. Wirotwanit N. The Effectiveness of Implementing the Nurse Practice Guideline among Patients with Sepsis at Emergency Department, Naresuan University Hospital. J Nurs Heal Sci. 2018;12(1):84–94. (in Thai).

11. Lundberg JS, Perl TM, Wiblin T, Costigan MD, Dawson J, Nettleman MD, et al. Septic shock: an analysis of outcomes for patients with onset on hospital wards versus intensive care units. Crit Care Med. 1998;26(6):1020–4.

12. Pichai C. Factors for Mortality of Bacteremia in Surin Hospital Title. Buddhachinaraj Med. 2007;24(1):33–45. (in Thai).

13. Picard KM, O’Donoghue SC, Young-Kershaw DA, Russell KJ. Development and implementation of a multidisciplinary sepsis protocol. Crit Care Nurse [Internet]. 2006 Jun;26(3):43–54. Available from: https://pubmed.ncbi.nlm.nih.gov/16717386

14. Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2001;345(19):1368–77.

15. Chirawatkul A. Statistics for Health Science Reseaech. 4th ed. Wittayapat, Bangkok 2015. (in Thai).

16. Mahantassanapong C. Outcome of the Surin Sepsis Treatment Protocol in Sepsis Management. Srinagarind Med J. 2012;27(4):332–9. (in Thai).

17. Komon P, Namjuntra R, Binhosen V. Quality of care management in Persons with Sepsis Syndrome at emergency department in Singburi Hospital. APHEIT Int. 2017;2(2):32–43. (in Thai).

18. Nueng Nasuwan W, Normkusol J, Thongjam R, Panaput T. Development of the nursing service system for patients with severe sepsis. J Nurs Heal Care. 2014;32(2):25–36. (in Thai).

19. Onswadipong P, Sungkard K, Ayuthya SKN, Rongrungruan Y. The effect of early goal-directed nursing intervention on severity of organ failure in patients with sepsis syndrome. Nurs Sci J Thail. 2011;29(2):102–10. (in Thai).

20. Levy MM, Dellinger RP, Townsend SR, Linde-Zwirble WT, Marshall JC, Bion J, et al. The Surviving Sepsis Campaign: results of an international guideline-based performance improvement program targeting severe sepsis. Intensive Care Med. 2010;36(2):222–31.

21. Maley JH, Gaieski DF, Mikkelsen ME. Early Recognition: The Rate-Limiting Step to Quality Care for Severe Sepsis Patients in the Emergency Department. J Clin Outcomes Manag. 2015;22(5):211–21.

22. Torsvik M, Gustad LT, Mehl A, Bangstad IL, Vinje LJ, Damås JK, et al. Early identification of sepsis in hospital inpatients by ward nurses increases 30-day survival. Crit care. 2016;20(1):244-56.



How to Cite

Puripan N, Katsakun A, Palavutitotai N. Outcome of development of The Lerdsin Hospital Sepsis Protocol Checklist. JHNR [Internet]. 2020 Apr. 1 [cited 2022 Dec. 8];36(1):12-21. Available from: https://he01.tci-thaijo.org/index.php/bcnbangkok/article/view/242113



Research articles