Evaluation of the Utilization of Nursing Practice Guidelines for Sepsis Management on Clinical Outcomes among Patients with Sepsis in Medical Units.

Main Article Content

Tarntana Wongtawee
Apinya Siripitayakunkit
Soontaree Jianvitayakij

Abstract

This quasi-experimental research aimed to evaluate the utilization of nursing practice guidelines for sepsis management on clinical outcomes among patients with sepsis. Donabedian’s model was used as a conceptual framework for the implementation of guidelines. The samples consisted of 32 patients with sepsis and 43 medical staff nurses who were recruited for this study from September 2019 to January 2020. The research instrument included the Nursing Practice Guidelines for Sepsis Management, the Personal Data Recording Form, the Nursing Care’ s Checklist Form, the Sequential Organ Failure Assessment (SOFA) Form, the Septic Shock Assessment Form, and the Feasibility of Nursing Practice Guidelines for Implementing in Medical Units Questionnaire. Descriptive statistics and Mann-Whitney U test were used to analyze the data. The results showed that the most common signs and symptoms of patients with sepsis were fever, SBP lower than 100 mmHg, tachypnea, and tachycardia, respectively. Almost all of the nurses practiced and followed the guidelines. However, some activities that did not completely adhere to the guidelines included recording of mean arterial pressure, giving broad-spectrum antibiotics within one hour, and monitoring of patients during the transfer, respectively. After using the guidelines, the level of SOFA decreased in 48 hours as compared to the baseline SOFA scores. Approximately 10% of sepsis patients turned to have septic shock and were transferred to the ICU within 6 hours. From this study, most nurses were satisfied with the guidelines and reported that it is feasible to manage the sepsis. However, the more specific guidelines that should be
developed include the protocol of early antibiotic administration within one hour, the training program for nurses to care for patients with sepsis, and practice guidelines in collaboration with the multidisciplinary team to improve the care quality in patients with sepsis.
Keywords: Nursing practice guidelines, Sepsis, Clinical outcomes, Severity of organ failure,Septic shock

Article Details

How to Cite
1.
Wongtawee T, Siripitayakunkit A, Jianvitayakij S. Evaluation of the Utilization of Nursing Practice Guidelines for Sepsis Management on Clinical Outcomes among Patients with Sepsis in Medical Units. Nurs Res Inno J [Internet]. 2021 Apr. 2 [cited 2024 Nov. 22];26(2):155-71. Available from: https://he02.tci-thaijo.org/index.php/RNJ/article/view/241869
Section
บทความวิจัย

References

Phipatvej K. Predisposing factors of mortality in septic patients in Uttaradit Hospital. Thai Journal of Cardio-

Thoracic Nursing. 2008;29:135-43. (in Thai)

Rivers E, Ahrens T. Improving outcomes for severe sepsis and septic shock: tools for early identification for at-risk patients and treatment protocol implementation. Crit Care Clin. 2008;23:1-47.

Sagy M, Al-Qaqaa Y, Kim P. Definitions and pathophysiology of sepsis. Curr Probl Pediatr Adolesc Health Care. 2013;43:260-63.

The Thai Society of Critical Care Medicine. Severe Sepsis and Septic Shock Medical Practice Guidelines [document on the internet]. The Institute; 2016 [cited 2017 August1]. Available from:http://www.criticalcarethai.org/ (inThai)

Levy MM, Evans LE, Rhodes A. The surviving sepsis campaign bundle: 2018 update. Intensive Care Med.

;1-4.

Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock:2016. Crit Care Med. 2017;45(3):1-67.

Medical Information Division, Faculty of Medicine Ramathibodi Hospital. Statistic of patients with sepsis in

Faculty of Medicine Ramathibodi Hospital; 2017.

Ministry of Public Health. Key Performance Indicators [document on the internet]. The Institute; 2019 [cited

April 19]. Available from: http://healthkpi.moph.go.th/kpi/kpi/index/?id=43&kpi_year=2560. (inThai)

Drumheller BC, Agarwal A, Mikkelsen ME, Sante C,Weber AL, Goyal M, et al. Risk factors for mortality

despite early protocolized resuscitation for severe sepsis and septic shock in the emergency department. Crit Care.2016:13-20.

Kang CI, Song JH, Chung DR, Peck KR, Ko KS, Yeom JS, et al. Risk factors and pathogenic significance of severe

sepsis and septic shock in 2286 patients with gramnegative bacteremia. J Infect. 2011:26-33.

Song Y, Shin T, Jo SI, Jeong SY, Kang M, Sim M, et al.Predicting factors associated with clinical deterioration of

sepsis patients with intermediate levels of serum lactate.SHOCK. 2012;38(3):249-54.

Donabedian A. An introduction to quality assurance in health care. AJPM. 2003;26(1):96.

Burch VC, Tarr G, Morroni C. Modified early warning sign score predicts the need for hospital admission and

inhospital mortality. Emerg Med J. 2008;25:674-78.

Sutherasan Y, Theerawit P, Suporn A, Nongnuch A,Phanachet P, Kositchaiwat C. The impact of introducing

the early warning scoring system and protocol on clinical outcomes in tertiary referral university hospital.

Therapeutics and Clinical Management. 2018;14:2089-95.

Thuamklad O, Janepanish Visudtibhan P, Siripitayakunkit A. Knowledge for detection and management in the early stage of septic shock patients and related factors among registered nurses in a university affiliated hospital.2014:206-20. (in Thai)

Benner P. From novice to expert. Am J Nurs.2001;82(3):402-7.

Kleinpell R, Aitken L, Schorr CA. Implications of the new international sepsis guidelines for nursing care. Am J Crit Care. 2013;22(3):212-22.

Torsvik M, Gustad LT, Mehl A, Bangstad IL, Vinje LJ,Damas JK, et al. Early identification of sepsis in hospital

inpatients by ward nurses increases 30-day survival. Critcare. 2016;20(244):1-9.

Smith EL, Rice KL, Winterbottom F. Nurses’ critical role in identifying sepsis and implementing early goal-directed therapy. J Contin Educ Nurs. 2012;43(6):247-8.

Saengsanga P, Kiamkan N. Outcomes of using the clinical practice guidelines for patients with severe sepsis or septic shock care according to sepsis bundle protocol at the ICU of Songkhla Hospital Thailand. Med J. 2015;29:403-10.(in Thai)

Nueng Nasuwan W, Normkuson J, Thongjam R, Panaput T. Development of the nursing service system for paients with severe sepsis. Journal of Nursing and Health Care.2014;32(2):25-36. (in Thai)

Onswadipong P, Sungkard K, Kusuma Na Ayuthya S,Rongrungruan Y. The effect of early goal-directed nursing intervention on severity of organ failure in patients with sepsis syndrome. Journal of Nursing Science.

;29(2):102-10. (in Thai)

Drahnak DM, Hravnak M, Ren D, Haines AJ, Tuite P.Scriping nurse communicating to improve sepsis care. Crit

Care Nurs. 2015;25(4):233-9.

Bowen DJ, Kreuter M, Spring B, Cofta-Woerpel L, Linnan L, Weiner D, et al. How we design feasibility studies.

AJPM. 2009;36(5):452-7.

Bunburaphong T. Transport of critical ill patients. In:Permpikul C, Staworn D, editor. Critical Care: guideline

and standards. Beyond Enterprise Company; 2004.257.(in Thai)

Vincent JL, Moreno R, Takala J, Willatts S, De Mendonca A, Bruining H, et al. The SOFA (Sepsis-related Organ

Failure Assessment) score to describe organ dysfunction/failure. Intensive Care Med. 1996;22:707-10.

Kongsayreepong S. Current concepts in critical care. 1sted. Bangkok: Ruenkaew Printing; 2000. (in Thai)

Power committee Nursing Division Siriraj Hospital.Interrater Reliability: IRR-Testing. [document on the

internet]. no date [cited 2019 August 19]. Available from:https://www.si.mahidol.ac.th/Th/division/nursing/

NDivision/N_HR/admin/download_files/73_73_1.pdf(in Thai)

Armen SB, Freer CV, Showalter JW, Crook T, Whitener CJ, West C, et al. Improving outcomes in patients with

sepsis. J Med Qual. 2016;31(1):56-63.

Girardis M, Rinaldi L, Donno L, Marietta M, Codeluppi M, Marchegiano P, et al. Effects on mamagement and

outcome of severe sepsis and septic shock patients admitted to the intensive care unit after implementation of a sepsis program: pilot study. Crit Care. 2009;13(5):1-8.

Kissoon N. Sepsis guideline implementation: benefits,pitfalls and possible solution. Crit Care. 2014;18(207):1-8.

Pollach G, Namboya F. Preventing intensive care admissions for sepsis in tropical Africa (PICASTA): an

extension of the international pediatric global sepsis initiative: an African perspective. Prediatr Crit Care Med.

;14(6):644-5.

Funk DJ, Kumar A. Antimicrobial therapy for lifethreatening infection: speed is life. Crit Care Clin.

;27(1):53-76.

Fischer F, Lange K, Klose K, Greiner W, Kraemer A.Barriers and strategies in guideline implementation-a

scoping review. Healthcare. 2016;4:1-36.

Abrahamson KA, Fox RL, Doebbling BN. Original research: facilitators and barriers to clinical practice

guideline use among nurses. Am J Nurs. 2012;112(7):26-35.

Bayley MT, Hurdower A, Richards CL, Korner-Bitensky N, Wood-Dauphinee S, Eng JJ, et al. Barriers to

implementation of stroke rehabilitation evidence: findings from a multi-site pilot project. Disabil Rehabil.

;34(19):1633-8.

Girard TD, Opal SM, Ely EW. The immunopathogenesis of sepsis in elderly patients. Clin Infect Dis. 2005:504-12.

Glickman SW, Cairns CB, Otero RM, Woods CW, Tsalik EL, Langley RJ, et al. Disease progression in

hemodynamically stable patient presenting to the emergency department with sepsis. SAEM. 2010;17

(4):383-90.

Wacharasint P, Nakada T, Boyd JH, Russell JA, Walley KR. Normal-range blood lactate concentration in septic

shock is prognostic and predictive. SHOCK. 2012;38(1):4-10.

Park DW, Chun BC, Kim JM, Sohn JW, Peck KR, KimYS, et al. Epidemiological and clinical characteristics of

community-acquired severe sepsis and septic shock: a prospective observational study in 12 university hospital

in Korea. JKMS. 2012;27(11):1308-14.