Critical Three Hours of Sepsis in the Emergency Department

In the Emergency room (ER), diagnosis of sepsis is often delayed and treatment is prolonged. Through education of signs, symptoms and treatment there is hope to decrease mortality rates in a local hospital. This will be accomplished by staff education, implementation of an algorithm and standardizing the sepsis treatment bundle. Sepsis continues to be a large contributor of mortality affecting people of all ages. Sepsis accounts for nearly 34.7 -52 % of all deaths and 56% of all admissions to the ICU (JAMA, 2015). One of the greatest challenges with sepsis is timely recognition of symptoms and initiation of early goal directed therapy. The golden standard of sepsis is to initiate the sepsis bundle with the first positive detection of sepsis, and initiate antibiotics within the first six hours of sepsis recognition. Prolonged recognition of sepsis poses an increased risk for complications including multi organ dysfunction syndrome (MODS), severe sepsis and mortality. Early detection and initiation of the sepsis bundle has been shown to minimize these risks resulting in better patient outcomes. The Surviving Sepsis Campaign created the sepsis bundle based on evidence based practice. It was developed to decrease mortality and morbidity of sepsis. A widespread adoption of the sepsis bundle is necessary to reduce risk. The objectives for this project are as follows: provide education to ER nurses to help them recognize and initiate treatment for sepsis patients as soon as possible, provide an algorithm for medical staff to use for guidance of diagnosis and implement a treatment plan of a septic patient as quickly as possible, and dissemination of the completed project. A review of the literature indicated that early recognition and rapid treatment is significant for enhanced outcomes. Education for the healthcare team incorporating a multi-disciplinary approach, should include the following sepsis diagnostic criteria: Temperature greater than 38.3°C or less than 36.0°C, heart rate greater than 90 bpm, tachypnea respiratory rate greater than 20 breaths per minute, altered mental status, significant edema, positive fluid balance greater than 20 mL/ kilograms over 24 hours, hyperglycemia greater than 140 mg/dL in the absence of diabetes. Rapid treatment incorporates initiating the sepsis bundle (labs, blood cultures, fluids and antibiotics). Implementation includes creating a slide presentation and presentation at a staff meeting, providing an evaluation form so feedback can be used to revise final slide presentation prior to placing it on Learning Management System (LMS). Other steps included: obtaining an Institutional Review Board (IRB) approval, creating an algorithm for diagnosis and treatment that is approved by the medical content expert and providing copies to the medical director for dissemination of material to staff. Evaluation of each of these components was determined by completion of each step of the implementation process. Sepsis currently has a high mortality rate and continues to rise. Through education of therapeutic priorities and early implementation of the sepsis bundle, clinicians can decrease the rate of mortality by starting with improving early recognition of sepsis in patients in the emergency room. With early recognition comes rapid treatment by initiating the sepsis bundle and rapid fluid resuscitation the mortality rate of sepsis can be decreased.