OUTCOMES OF USING THE CLINICAL PRACTICE GUIDELINE FOR PATIENTS WITH SEPSIS AT FANG HOSPITAL, CHIANGMAI PROVINCE

Abstract

ABSTRACT

BACKGROUND          

         Sepsis is status that increasing of incidence and it is the first of hospital death. The application of clinical practice guideline for sepsis by an effective multidisciplinary team can reduce the mortality rate of patients.

OBJECTIVES

         To compare clinical outcomes before and after application of clinical practice guideline and to study the operational quality of care for patients with sepsis.

METHODS

         The study was an observational study with historical control. The data of pre-guideline period collected by retrospective review of medical records during October 2016 – March 2017 were compare to those of post-guideline period collected during April 2017 – September 2017.  Data were analyzed by using descriptive statistics and chi-square test, Fisher Exact test and Independent t test respectively.

RESULTS

         246 patients with sepsis or septic shock were included. 85 patients were in pre-CPG periods and 161 patients were in post-CPG periods. The mortality rate was reduced from 28.2% to 21.1% meanwhile, rate of the hemocultures test before antibiotics prescription and initial therapy within 1 hour of sepsis onset decreased from 81.2.7% to 60.2% and 44.7% to 29.2% Furthermore, rate of fluid replacement therapy within 1 hour and rate of intensive management within 3 hour decreased from 20.0% to 19.3%.

 CONCLUSIONS AND DISCUSSIONS  
         The CPG for sepsis is effective in reducing in-hospital mortality rate. The reciprocal decrease in process results indicates that the CPG implementation might imperfect and requires further improvement.