Effects of the first-hour nursing intervention bundle on selected outcomes among patients with sepsis and septic shock in an emergency department

  • สุทธิชัย แก้วหาวงค์ โรงพยาบาลสมเด็จพระยุพราชธาตุพนม
  • ดลวิวัฒน์ แสนโสม
Keywords: first-hour nursing intervention bundle, patients with sepsis and septic shock, organ dysfunctions

Abstract

This quasi-experimental research with posttest-only design aimed to compare effects of the First-hour Nursing Intervention Bundle (1-NIB) on selected outcomes among patients with sepsis and septic shock in an emergency department (ED), Thatphanom Crown Prince Hospital. Purposive sampling was used to recruit 94 subjects for this study. The samples were divided into 2 groups. The comparison group included 47 subjects who received conventional sepsis management intervention whereas the experimental group were 47 subjects who received 1-NIB for sepsis management. Effects of the 1-NIB were evaluated to acquire patients’ and nurses’ outcomes. Descriptive statistics were used to obtain means, standard deviations, frequency, and percentage.  Effects of the 1-NIB were calculated using Chi-squared and relative risk.

       Evaluation of patient outcomes showed that 30 patients in the comparison group developed organ dysfunction with the incidence rate of 63.83/1000-persons (95%CI: 51.47-79.12) while only 9 patients in the experimental group developed organ dysfunction with the incidence of 19.14/1000- persons (95%CI: 10.64-34.45). In addition, patients in the comparison group were 3.33 times more likely to develop organ dysfunction within the first 6 hours of ED visit compared to those in the experimental group (RR=3.33, 95%CI=1.78-6.23, p=.0002).  Nurses using 1-NIB reported a high level of adherence (90.21%).  In addition, nurses caring for the experimental group had higher proportion in starting antibiotics within the first hour of ED visit, giving adequate IV fluid for resuscitation within the first hour, and closely monitoring and evaluating patient symptoms.  As a result, the 1-NIB decreased the incidence, risk, and severe symptom severity in patients with sepsis and septic shock. Moreover, it enhanced nurse’s competency and performance in caring for this patient population as well as decreased the time taken to initiate patient care. 

Downloads

Download data is not yet available.

References

1. Shankar-hari M, Phillips GS, Levy ML, Christopher W, Liu VX, Angus DC, et.al. Developing a New Definition and Assessing New Clinical Criteria for Septic Shock (Sepsis 3). JAMA 2017; 315(8): 775–787.
2. Mehta Y, Kochhar G. Sepsis and Septic Shock. Journal of Cardiac Critical Care TSS 2017; 1(1): 3-5.
3. World health Organization. Improving the prevention, diagnosis and clinical management of sepsis. 2017.
4. Fleischmann C, Scherag A, Adhikari NK, Hartog CS, Tsaganos T, Schlattmann. Assessment of global incidence and mortality of hospital-treated sepsis current estimates and limitations. American Journal of Respiratory and Critical Care Medicine 2016; 193(3): 259–272.
5. สำนักนโยบายและยุทธศาสตร์.สถิติสาธารณสุข พ.ศ. 2558: Public Health Statistis 2015.กรุงเทพฯ: โรงพิมพ์องค์การสงเคราะห์ทหารผ่านศึก; 2559.
6. Gotts EJ, Matthay AM. Sepsis: pathophysiology and clinical management. British Medical Journal 2016
7. Bloos F, Thomas-Ruddel D, Ruddel H, Engel C, Schwarzkopf D, John CM. Impact of compliance with infection management guidelines on outcome in patients with severe sepsis: a prospective observational multi-center study. Critical Care 2014; 18(2): R42.
8. Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM. Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock: 2012. Crit Care Med 2013; 41:580-637.
9. Finkelsztein EJ, Jones DS, Ma KC, Pabón MA, Delgado T. Nakahira K. Comparison of qSOFA and SIRS for predicting adverse outcomes of patients with suspicion of sepsis outside the intensive care unit. Critical Care 2017; 21(1): 73.
10. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D. Bauer M, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA 2016; 315(8): 801–10.
11. Levy MM, Evans LE, Rhodes A. The surviving sepsis campaign bundle: 2018 update. Intensive Care Med 2018; 44:925-928
12. โรงพยาบาลนครพนม. เอกสารโครงการพัฒนาระบริการสาขาโรคติดเชื้อ (Service plan sepsis).โรงพยาบาลนครพนม เครือข่ายเขตสุขภาพที่8 (ไม่ได้ตีพิมพ์). 2560
13. ปฏิพร บุณยพัฒน์กุล. ประสิทธิผลของระบบการบริการสุขภาพฉุกเฉินต่ออาการทางคลินิกในผู้ป่วยที่มีภาวะพิษเหตุติดเชื้อ.(วิทยานิพนธ์) คณะแพทยศาสตร์โรงพยาบาลรามาธิบดี มหาวิทยาลัยมหิดล; 2558
14. Andaluz D, Ferrer R. SIRS, qSOFA, and organ failure for assessing sepsis at the emergency department. Journal of Thoracic Disease 2017; 9(6): 1459-1462.
15. Geoffrey EH, Rachel ET, Rachel S, Joseph DL, Aaron MB, Andrew JS. et.al. Triage sepsis alert and sepsis protocol lower times to fluids and antibiotics in the ED. American Journal of Emergency Medicine 2016; 34(2016): 1-9.
16. Ho KM, Lan, NS. Combining quick Sequential Organ Failure Assessment with plasma lactate concentration is comparable to standard Sequential Organ Failure Assessment score in predicting mortality of patients with and without suspected infection. Journal of Critical Care 2017; 38(2017): 1–5.
17. เพ็ญศรี อุ่นสวัสดิพงษ์, กรองกาญจน์ สังกาศ, ศศิมา กุสุมา ณ อยุธยาและยงค์ รงค์รุ่งเรือง. ผลของกิจกรรมพยาบาลมุ่งเป้าในระยะ 6 ชั่วโมงแรกต่อความรุนแรงของอวัยวะล้มเหลวในผู้ป่วยที่มีกลุ่มอาการ sepsis. Journal of Nursing Science 2554; 29(2): 102-110.
18. Elizabeth NR, Karen LT, James AR. Barriers to clinical practice guideline implementation for sepsis patients in the emergency department. Journal of Emergency Nursing 2018); 44(6): 552-556.
19. Elizabeth RT, Kimberly W, Melanie H, Brenda SB, Kimberly S. Interprofessional collaboration to improve sepsis care and survival within a tertiary care emergency department. Journal of emergency nursing 2017; 43(6): 532-538.
20. Damiani E, Donati A, Serafini G, Rinaldi L, Adrario E, Pelaia P.et.at. Effect of performance improvement programs on compliance with sepsis bundles and mortality: A systematic review and meta-analysis of observational studies. PLoS ONE 2015; 10(5): 1–24.
21. วิไลวรรณ เนื่อง ณ สุวรรณ, จิราพร น้อมกุศล, รัตนา ทองแจ่ม, ธนชัย พนาพุฒิ. การพัฒนาระบบการพยาบาลผู้ป่วยที่มีภาวะติดเชื้อในกระแสเลือดอย่างรุนแรง.วารสารการพยาบาลและการดูแลสุขภาพ 2557; 32(2): 25-36.
22. Elizabeth W. Raising awareness for sepsis, septic screening, early recognition, and treatment in the emergency department. Journal of emergency nursing 2018; 44(3): 224-22
Published
2020-03-27