| Description |
Sepsis is the leading cause of death in the hospital setting. According to the Surviving Sepsis Campaign, early identification of sepsis and intervention with early goal-directed therapy protocols that include administration of antibiotics improve patient outcomes. Often, there are delays in the recognition of early sepsis by clinical staff, as the symptoms are subtle and difficult to detect. Individual symptoms are sub-acute but the constellation of symptoms indicates impending, serious illness. Delayed recognition has been associated with increased mortality. In the United States, the Institute of Health Care Improvement (IHI) and the Centers for Medicare and Medicaid (CMS) are encouraging health care systems across the country to improve sepsis care. As of October 2015, CMS is now determining reimbursement for sepsis and sepsis-related diagnoses based on the care the patient receives in the initial three hours after presentation. This is measured by the earliest charted documentation of symptoms or clinical values that may indicate sepsis. As a result, many health care systems are implementing early warning score tools such as the Modified Early Warning Score (mEWS) to help identify patients at risk for clinical deterioration with syndromes such as sepsis. In October of 2015, the Acute Care Clinic (ACC), an urgent care clinic at a large NCI-accredited cancer center, started piloting an institution-specific calculated Modified Early Warning Score (mEWS). In this system, a numerical value is assigned to vital signs based on each parameter's degree of deviation from normal. The administrative staff within this institution has determined the pre-defined score at which they would like the providers to act. At minimum they would do an immediate physical evaluation of the patient and determine if sepsis is emerging. The purpose of this project was to determine if having a modified early warning score calculated on every patient's vital signs upon initial triage helped clinicians identify at-risk patients, thus improving time to antibiotic administration for septic patients within the ACC. Four objectives were identified for this project. The first objective was to obtain IRB approval for a retrospective chart review of two different cohorts of patients; one prior to and one after implementation of the mEWS. Once IRB approval was obtained, the second objective was data collection. The first cohort included consecutive patients evaluated during the time frame of January 1, 2015, to January 31, 2015, prior to the implementation of mEWS. The second cohort included consecutive patients evaluated during the time frame of January 1, 2016, to January 31, 2016. The mEWS was implemented in clinic in December 2015. In this chart review, demographic and clinical data were recorded, which included: age, sex, diagnosis (visit and cancer), antibiotic administration time, and vital signs recorded at presentation. A mEWS score was then calculated based on those initial vital signs. The third objective was to evaluate the data. The data was compared in both cohorts of patients. Analysis of the data included statistical analysis and adjustments for confounding variables. Results were then analyzed, assessed, and organized. The fourth objective was to disseminate the data and the project conclusions. A poster presentation was presented to the College of Nursing and to the administration of the institution where the study took place. |
