Development of a Nursing Care Model for Patients with Bloodstream Infections in the Emergency and Trauma Department at Mueang Suang Hospital
Keywords:
Sepsis Management, Emergency Nursing, Bloodstream Infection (BSI), Care Bundle ImplementationAbstract
Purpose: To study current situation and problems, develop a care model, implement model, and evaluate and improve the nursing care model for patients with sepsis in emergency department.
Study Design: A research and development (R&D) design was employed.
Materials and Methods: Phase 1 assessed current problems via medical records of 94 BSI patients and focus groups with 10 ED staff (physicians, nurses, EMTs). Phase 2 developed the model using expert validation (n=3). Phase 3 implemented the model with 20 ED staff and 46 BSI patients. Phase 4 evaluated outcomes using pre/post-test questionnaires, checklists, and descriptive statistics/%difference analysis (January-June 2025). Nursing practice was assessed by 20 nurses.
Main findings: Key systemic challenges were identified across providers, patients, and resources. The resulting "ABOD Model" integrates: (1) Sepsis Alert, (2) Sepsis Bundle: 6 Actions within 1 Hour, (3) Ongoing Management & Escalation, and (4) Discharge Criteria. Post-implementation data revealed: 1)Significant demographic shifts: Mean patient age (67.2 to 59.2 years; p<0.05), alcohol use prevalence. 2) Improved timeliness: Time to physician notification. 3)Critical clinical outcomes: Septic shock incidence, and 4) Enhanced protocol compliance: Overall nursing practice scores from 92.50 to 95.25 (+1.94% improvement; p<0.05), rated as "Good" (mean 1.91±0.12). Perfect scores (2.00±0.00) were achieved in blood culture collection, 1-hour fluid/antibiotic administration, urinary catheterization, and transfer readiness.
Conclusion and Recommendations: The ABOD Model significantly improved sepsis recognition, bundle compliance, and clinical outcomes in the ED. Sustained implementation requires long-term evaluation to ensure durability. This model offers a validated framework for optimizing BSI care in acute settings.
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