Effects of Fluid Management Clinical Nursing Practice Guideline (CNPG) on Selected Outcomes in Patients with Sepsis at Emergency Department, Chum Phae Hospital

  • อัมพร ระวังดี นักศึกษาหลักสูตรพยาบาลศาสตรมหาบัณฑิต สาขาการพยาบาลผู้ใหญ่ คณะพยาบาลศาสตร์มหาวิทยาลัยขอนแก่น
  • นงลักษณ์ เมธากาญจนศักดิ์ ผู้ช่วยศาสตราจารย์ สาขาการพยาบาลผู้ใหญ่ คณะพยาบาลศาสตร์มหาวิทยาลัยขอนแก่น
Keywords: Fluid management, Sepsis, Clinical nursing practice guideline (CNPG)

Abstract

In patients with sepsis, the management of fluids during initial hemodynamic resuscitation remains a major therapeutic challenge. However, there are several risks and conditions which may predispose to severe life-threatening. This study was aimed to evaluate the effects of fluid management in clinical nursing practice guideline (CNPG) on selected outcomes in patients with sepsis at the emergency department of Chum Phae hospital. A quasi-experimental with non-randomized control–group pretest-posttest design has been adopted for the study. A total of 60 patients with sepsis were included in this study which started from March to July 2019. The comparison group (30 cases) was treated with standard sepsis protocol treatment while the experimental group (30 cases) was treated with standard sepsis protocol treatment and fluid management CNPG. Unless otherwise stated, data are presented as mean ± SD. Statistics analyses were performed using the SPSS version 20 software package. Significant differences were assessed by independent t-test, chi-square test and relative risk (RR).

Results indicated that the comparison group patients had significant lower Mean Arterial Pressure (MAP) at hour 1 and hour 3 compared to the experimental group patients. MAP at hour 1 were 67.67 mm Hg versus (vs.) 73.07 mm Hg (SD 4.78, SD 8.58) and MAP at hour 3 were 72.20 mm Hg vs. 78.20 mm Hg (SD 4.78, SD 8.58). Comparison group patients also had significant lower serum lactate level at hour 3 and hour 6 compared to the experimental group patients. Serum lactate level at hour 3 were 3.36 mmol/L vs. 2.17 mmol/L (SD 1.31, SD .85) and serum lactate level at hour 6 were 3.39 mmol/L vs. 1.76 mmol/L (SD 1.71, SD .61). In addition, patients with fluid management CNPG had 1.58 times greater chance to increase MAP ≥ 65 mm Hg at hour 1 compared to the patients without fluid management CNPG (RR = 1.58, 95% CI 1.70–27.75). The experimental group patients had 4 times greater chance to decrease serum lactate level < 2 mmol/L (hour 3) compared to the comparison group patients (RR = 4, 95% CI 1.48–24.99). The experimental group patients had also 3.14 times greater chance to decrease serum lactate level < 2 mmol/L (hour 6) compared to the comparison group patients (RR =3.14, 95% CI 2.8–29.13). patients with fluid management CNPG had 1.58 times greater chance to increased MAP ≥ 65 mm Hg (hour 1) compared to the patients without fluid management CNPG (RR = 1.58, 95% CI 1.70–27.75). In patients with fluid management CNPG of 1.61 times has a greater chance to increase urine output ≥ 0.5 mL/kg/hr (hour 3) compared to the comparison group patients (RR = 1.61, 95% CI 2.31–161.56). Registered nurses adhered to fluid management CNPG in high level were 97.50% (SD 6.53), and they were very satisfied to use fluid management CNPG at 4.69 points. (SD 0.47).

As a result, fluid management CNPG resulted in patients safety, increased nurses adherences and increased nurses satisfaction. To confirm these effects, future studies are needed to continue fluid management CNPG to ICU or semi-ICU as recommended.

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Published
2020-03-26