![Page 1: Emergency Nurses Show Leadership in Sepsis Screening...Ireland. HSE (2016) Framework for Improving Quality in our Health Service Part 1: Introducing the Framework, Dublin: HSE Ireland](https://reader033.vdocuments.us/reader033/viewer/2022050406/5f83d59a4f053104d40e7c1b/html5/thumbnails/1.jpg)
Emergency Nurses Show Leadership in Sepsis Screening
SARAH WATKINS
EMERGENCY NURSE/PHD CANDIDATE
Cork University Hospital
Annual Nursing Conference
23rd may 2017
![Page 2: Emergency Nurses Show Leadership in Sepsis Screening...Ireland. HSE (2016) Framework for Improving Quality in our Health Service Part 1: Introducing the Framework, Dublin: HSE Ireland](https://reader033.vdocuments.us/reader033/viewer/2022050406/5f83d59a4f053104d40e7c1b/html5/thumbnails/2.jpg)
Background
A retrospective audit
350 samples of nursing records (ADULTS) in the November 2014
1. Comprehensive assessment
2. Clear articulation of ED nurse’s role
3. Integrated evidence base
![Page 3: Emergency Nurses Show Leadership in Sepsis Screening...Ireland. HSE (2016) Framework for Improving Quality in our Health Service Part 1: Introducing the Framework, Dublin: HSE Ireland](https://reader033.vdocuments.us/reader033/viewer/2022050406/5f83d59a4f053104d40e7c1b/html5/thumbnails/3.jpg)
Question
How did nurses contribute to the emergency service?
What were ED nurses doing to help in detecting Sepsis?
![Page 4: Emergency Nurses Show Leadership in Sepsis Screening...Ireland. HSE (2016) Framework for Improving Quality in our Health Service Part 1: Introducing the Framework, Dublin: HSE Ireland](https://reader033.vdocuments.us/reader033/viewer/2022050406/5f83d59a4f053104d40e7c1b/html5/thumbnails/4.jpg)
Leadership in Nursing
ORGANISATIONAL NEED TO MEASURE OUTPUTS/PERFORMANCE
NURSING MANDATE TO PROVIDE EVIDENCE THAT WE ARE ASSESSING, EVALUATING CARE DELIVERY
BASIC CARE FAILURES
HIQA NMBI
MEDIA
![Page 5: Emergency Nurses Show Leadership in Sepsis Screening...Ireland. HSE (2016) Framework for Improving Quality in our Health Service Part 1: Introducing the Framework, Dublin: HSE Ireland](https://reader033.vdocuments.us/reader033/viewer/2022050406/5f83d59a4f053104d40e7c1b/html5/thumbnails/5.jpg)
Leadership in Nursing
SAVITA HALAPPANAVAR (2012) – UNIVERSITY HOSPITAL GALWAY
TANIA AND ZACH MCCABE (2007) – OUR LADY OF LOURDES DROGHEDA
? - UNIVERSITY HOSPITAL LIMERICK
![Page 6: Emergency Nurses Show Leadership in Sepsis Screening...Ireland. HSE (2016) Framework for Improving Quality in our Health Service Part 1: Introducing the Framework, Dublin: HSE Ireland](https://reader033.vdocuments.us/reader033/viewer/2022050406/5f83d59a4f053104d40e7c1b/html5/thumbnails/6.jpg)
ED Nurse
Screening to identify patients who have Sepsis
Initiating the diagnostic workup
Reducing door to needle time for administration of intravenous antibiotics
(Bruce et al. 2015, Gatewood et al. 2015)
![Page 7: Emergency Nurses Show Leadership in Sepsis Screening...Ireland. HSE (2016) Framework for Improving Quality in our Health Service Part 1: Introducing the Framework, Dublin: HSE Ireland](https://reader033.vdocuments.us/reader033/viewer/2022050406/5f83d59a4f053104d40e7c1b/html5/thumbnails/7.jpg)
Objectives
1. Develop a Nursing Proforma
2. Comprehensive Assessment
3. Integration of best evidence
4. Articulate the ED nurse’s role
5. Capture detection rate /important data – time to blood cultures, time to first lactate and time to antimicrobials.
![Page 8: Emergency Nurses Show Leadership in Sepsis Screening...Ireland. HSE (2016) Framework for Improving Quality in our Health Service Part 1: Introducing the Framework, Dublin: HSE Ireland](https://reader033.vdocuments.us/reader033/viewer/2022050406/5f83d59a4f053104d40e7c1b/html5/thumbnails/8.jpg)
Methods
Pilot of Nursing Proforma (Adults) November 2015
![Page 9: Emergency Nurses Show Leadership in Sepsis Screening...Ireland. HSE (2016) Framework for Improving Quality in our Health Service Part 1: Introducing the Framework, Dublin: HSE Ireland](https://reader033.vdocuments.us/reader033/viewer/2022050406/5f83d59a4f053104d40e7c1b/html5/thumbnails/9.jpg)
Leadership in Nursing
• Learning/Sharing information
• Patient Experience/Involvement
• Clinical Effectiveness/Audit
• Managing risk/patient safety
• Proactive service improvement
• Consultation and communication
![Page 11: Emergency Nurses Show Leadership in Sepsis Screening...Ireland. HSE (2016) Framework for Improving Quality in our Health Service Part 1: Introducing the Framework, Dublin: HSE Ireland](https://reader033.vdocuments.us/reader033/viewer/2022050406/5f83d59a4f053104d40e7c1b/html5/thumbnails/11.jpg)
Results
Sample : 30
Inclusion Criteria : 10% of all Adult patients who presented with suspicion of or confirmed infection in a 2 week period to ED in UHL. The sample was randomly selected from this criteria.
Exclusion Criteria : Paediatric patients, Pregnant women, Post-partum women up to 42 days.
![Page 12: Emergency Nurses Show Leadership in Sepsis Screening...Ireland. HSE (2016) Framework for Improving Quality in our Health Service Part 1: Introducing the Framework, Dublin: HSE Ireland](https://reader033.vdocuments.us/reader033/viewer/2022050406/5f83d59a4f053104d40e7c1b/html5/thumbnails/12.jpg)
Results
22/30 patients were
screened for and correctly
identified as Sepsis
21/30 transferred to
Resus on arrival
![Page 13: Emergency Nurses Show Leadership in Sepsis Screening...Ireland. HSE (2016) Framework for Improving Quality in our Health Service Part 1: Introducing the Framework, Dublin: HSE Ireland](https://reader033.vdocuments.us/reader033/viewer/2022050406/5f83d59a4f053104d40e7c1b/html5/thumbnails/13.jpg)
SEPSIS SIX 97% Fluids
100% Blood cultures
93% Lactate
100% Antimicrobials
53% Oxygen
50% Urine output
![Page 14: Emergency Nurses Show Leadership in Sepsis Screening...Ireland. HSE (2016) Framework for Improving Quality in our Health Service Part 1: Introducing the Framework, Dublin: HSE Ireland](https://reader033.vdocuments.us/reader033/viewer/2022050406/5f83d59a4f053104d40e7c1b/html5/thumbnails/14.jpg)
Conclusions
Triage Trigger/Trolley Trigger Screening
Comprehensive, standardised, evidence based assessment
Template for new/inexperienced ED nurses
Promotes seamless care transitions
![Page 15: Emergency Nurses Show Leadership in Sepsis Screening...Ireland. HSE (2016) Framework for Improving Quality in our Health Service Part 1: Introducing the Framework, Dublin: HSE Ireland](https://reader033.vdocuments.us/reader033/viewer/2022050406/5f83d59a4f053104d40e7c1b/html5/thumbnails/15.jpg)
Acute Services
Older people
Mental Health
Intellectual disability
Childrens
Midwifery
Public Health
![Page 16: Emergency Nurses Show Leadership in Sepsis Screening...Ireland. HSE (2016) Framework for Improving Quality in our Health Service Part 1: Introducing the Framework, Dublin: HSE Ireland](https://reader033.vdocuments.us/reader033/viewer/2022050406/5f83d59a4f053104d40e7c1b/html5/thumbnails/16.jpg)
Future Plan
Emergency Service
Sepsis
Falls Risk
![Page 17: Emergency Nurses Show Leadership in Sepsis Screening...Ireland. HSE (2016) Framework for Improving Quality in our Health Service Part 1: Introducing the Framework, Dublin: HSE Ireland](https://reader033.vdocuments.us/reader033/viewer/2022050406/5f83d59a4f053104d40e7c1b/html5/thumbnails/17.jpg)
References
Bruce, H.R., Maiden, J., Fedullo, P.F. & Kim, S.C. (2015) ‘Impact of Nurse – Initiated ED Sepsis Protocol on Compliance With Sepsis Bundles, Time to Initial Antibiotic Administration, And In-Hospital Mortality’, Journal of Emergency Nursing, 41(2), p. 130-137.
Gatewood, M., Wemple, M., Greco. S., Kritek, P.A. & Durvasula, R. (2015) ‘A quality improvement project to improve early sepsis care in the emergency department’{online]24. Available@http://qualitysafety.bmj.com/content/24/12/787#BIBL[Accessed: 2nd July 2016].
Ireland. HSE (2015) Guiding Framework for the Implementation of Nursing and Midwifery Quality Care Metrics in the Health Service Executive. Dublin: HSE.
Ireland. HSE (2016) Framework for Improving Quality in our Health Service Part 1: Introducing the Framework, Dublin: HSE
Ireland. DOH (2014) Sepsis Management National Clinical Guideline No. 6. Dublin: DOH.
![Page 18: Emergency Nurses Show Leadership in Sepsis Screening...Ireland. HSE (2016) Framework for Improving Quality in our Health Service Part 1: Introducing the Framework, Dublin: HSE Ireland](https://reader033.vdocuments.us/reader033/viewer/2022050406/5f83d59a4f053104d40e7c1b/html5/thumbnails/18.jpg)