The Development of Nursing-Care System for Sepsis and Septic Shock Patients in Chiang Mai Province Thailand

Abstract

Sepsis and septic shock are major public health problems due to the rapid onset of the critical disease and high mortality rate. The aim of this action research was to study sepsis and septic shock situations, develop caring system for patients with sepsis and septic shock and then evaluate the effective of system. Data were collected during March 2021 – February 2022. The study was conducted in three phases: 1) situation analysis phase 2) model development phase 3) evaluation phase. The research instruments included patient medical record, in-depth interview questionnaires, focus group discussion, participatory observations, and a model of nursing-care system for sepsis and septic shock.

The results revealed that the problems related to nursing care for patients with sepsis and septic shock reveal as follow 1) low rate of nursing care in NEW score 2) low rate of using screening and diagnosis tool 3) discordant in sepsis and septic shock caring between community hospitals and Nakornping hospital due to lack of caring protocol.

Model of nursing-care system for sepsis and septic shock patients consisted of 1) diagnosis criteria 2) assessment guideline 3) treatment protocol 4) 7 bundles practice guideline at ER and Ward 5) Chiangmai sepsis guideline 6) primary assessment for crisis patients and 7) SEPSIS standing order.

The effective of a model of nursing-care system for sepsis and septic shock patients in Nakornping hospital and community hospitals demonstrated as follow; rate of taking hemoculture before antibiotic treatment were increased by 4.6 vs. 14.3%, rate of providing intravenous fluids in the first hour were increased by 16.0 vs. 10.2%, rate of providing antibiotic treatment within 1 hour after diagnosis were increased by 4.6% while decreased by 2.6% in community hospitals, rate of ICU admission after physician consulting were increased by 18.2 vs. 2.8%,  rate of refer was increased by 4.9% in community hospital and mortality rate was increased in Nakorping hospital (2.5%) and decreased in community hospital(1.0%). All seven indicators were achieved (100%).

Conclusions: The situation of sepsis and septic shock are significant problem. Early recognition and appropriate management of a patient with sepsis are needed. The development of clinical guidelines and sepsis screening tools in nursing-care system are established methods to help reduce patient mortality.