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A3627 - Sepsis Screening in a Long-Term Care Hospital: Improving Timely Identification and Effective Treatment
Author Block: J. Brock1, G. D'Souza2, D. R. Nelson2, M. S. Hassenpflug2; 1Frontier Nursing University, Hyden, KY, United States, 2Barlow Respiratory Hospital, Los Angeles, CA, United States.
RATIONALE
Sepsis is associated with significant morbidity and mortality if not promptly recognized and treated. Long-term care hospitals (LTCH) are an increasingly common discharge location for patients following an episode of severe acute illness, many with the co-morbidity of sepsis. Barlow Respiratory Hospital (BRH) is a 105-bed LTCH network, accepting chronically critically ill (CCI) and medically complex patients transferred from acute care hospitals in southern California, the majority from intensive care units (ICU). The BRH main campus has a 6-bed ICU. To align with the Surviving Sepsis Campaign, a sepsis screening tool was added to nursing documentation each shift beginning in April 2017, linked to an evidence-based sepsis protocol. Our project examined compliance with and accuracy of completing the screening tool, and timely implementation of the sepsis protocol.
METHODS
Records of patients with ICU days at BRH from 4/2017 through 7/2017 were reviewed for compliance with sepsis screen, accurate interpretation of screen, and implementation of sepsis protocol. A needs assessment was performed to identify gaps in care. A four-hour critical care education module was provided by a certified critical care registered nurse educator to all registered nurses (RN) and respiratory care practitioners (RCP) in 8/2017. Subsequent weekly sepsis rounds with case review and focused educational topics were led by a board certified RN nurse practitioner. Staff self-evaluations for confidence in caring for patients with sepsis were completed during the sepsis rounds. A follow-up chart audit was performed during 9/2017-10/2017.
RESULTS
Initial chart review from 4/2017-7/2017 identified 20 patients with ICU days for sepsis. Of these patients, 65% (13/20) had complete sepsis screens; 50% (10/20) were accurately interpreted. Mean score compliance with the eight sepsis care bundle elements was 4.3. Follow-up record review identified 17 patients with ICU days for sepsis from 9/2017-10/2017. Completion of sepsis screens improved to 88% (15/17), with 65% (11/17) accurately interpreted. Mean score compliance with the eight sepsis care bundle elements increased to 5.6. An expanded chart audit in 10/2017 of 60 episodes of sepsis screening in the general patient population showed improved compliance with screen completion to 93% (53/60), with 80% (40/60) accuracy.
CONCLUSIONS
Education and focused case reviews were successful in improving sepsis screening compliance and accuracy. Determination of the impact of sepsis screening to inform treatment decisions, and effect patient outcomes in patients admitted to the LTCH in a state of CCI with persistent inflammation, is less clear.